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2196 Pre-treatment sleep disturbance as a risk factor for radiation therapy induced pain in 676 women with breast cancer
- Anita R. Peoples, Wilfred R. Pigeon, Dongmei Li, Joseph A. Roscoe, Sheila N. Garland, Michael L. Perlis, Vincent P. Vinciguerra, Thomas Anderson, Lisa S. Evans, James L. Wade III, Deborah J. Ossip, Gary R. Morrow, Julie R. Wolf
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, pp. 45-46
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OBJECTIVES/SPECIFIC AIMS: The purpose of the present secondary data analysis was to examine the effect of moderate-severe disturbed sleep before the start of radiation therapy (RT) on subsequent RT-induced pain. METHODS/STUDY POPULATION: Analyses were performed on 676 RT-naïve breast cancer patients (mean age 58, 100% female) scheduled to receive RT from a previously completed nationwide, multicenter, phase II randomized controlled trial examining the efficacy of oral curcumin on radiation dermatitis severity. The trial was conducted at 21 community oncology practices throughout the US affiliated with the University of Rochester Cancer Center NCI’s Community Oncology Research Program (URCC NCORP) Research Base. Sleep disturbance was assessed using a single item question from the modified MD Anderson Symptom Inventory (SI) on a 0–10 scale, with higher scores indicating greater sleep disturbance. Total subjective pain as well as the subdomains of pain (sensory, affective, and perceived) were assessed by the short-form McGill Pain Questionnaire. Pain at treatment site (pain-Tx) was also assessed using a single item question from the SI. These assessments were included for pre-RT (baseline) and post-RT. For the present analyses, patients were dichotomized into 2 groups: those who had moderate-severe disturbed sleep at baseline (score≥4 on the SI; n=101) Versus those who had mild or no disturbed sleep (control group; score=0–3 on the SI; n=575). RESULTS/ANTICIPATED RESULTS: Prior to the start of RT, breast cancer patients with moderate-severe disturbed sleep at baseline were younger, less likely to have had lumpectomy or partial mastectomy while more likely to have had total mastectomy and chemotherapy, more likely to be on sleep, anti-anxiety/depression, and prescription pain medications, and more likely to suffer from depression or anxiety disorder than the control group (all p’s≤0.02). Spearman rank correlations showed that changes in sleep disturbance from baseline to post-RT were significantly correlated with concurrent changes in total pain (r=0.38; p<0.001), sensory pain (r=0.35; p<0.001), affective pain (r=0.21; p<0.001), perceived pain intensity (r=0.37; p<0.001), and pain-Tx (r=0.35; p<0.001). In total, 92% of patients with moderate-severe disturbed sleep at baseline reported post-RT total pain compared with 79% of patients in the control group (p=0.006). Generalized linear estimating equations, after controlling for baseline pain and other covariates (baseline fatigue and distress, age, sleep medications, anti-anxiety/depression medications, prescription pain medications, and depression or anxiety disorder), showed that patients with moderate-severe disturbed sleep at baseline had significantly higher mean values of post-RT total pain (by 39%; p=0.033), post-RT sensory pain (by 41%; p=0.046), and post-RT affective pain (by 55%; p=0.035) than the control group. Perceived pain intensity (p=0.066) and pain-Tx (p=0.086) at post-RT were not significantly different between the 2 groups. DISCUSSION/SIGNIFICANCE OF IMPACT: These findings suggest that moderate-severe disturbed sleep prior to RT is an important predictor for worsening of pain at post-RT in breast cancer patients. There could be several plausible reasons for this. Sleep disturbance, such as sleep loss and sleep continuity disturbance, could result in impaired sleep related recovery and repair of tissue damage associated with cancer and its treatment; thus, resulting in the amplification of pain. Sleep disturbance may also reduce pain tolerance threshold through increased sensitization of the central nervous system. In addition, pain and sleep disturbance may share common neuroimmunological pathways. Sleep disturbance may modulate inflammation, which in turn may contribute to increased pain. Further research is needed to confirm these findings and whether interventions targeting sleep disturbance in early phase could be potential alternate approaches to reduce pain after RT.
9 - Effect of urban structures on diversity of marine species
- Edited by Mark J. McDonnell, Royal Botanic Gardens, Melbourne and University of Melbourne, Amy K. Hahs, Royal Botanic Gardens, Melbourne and University of Melbourne, Jürgen H. Breuste, Universität Salzburg
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- Book:
- Ecology of Cities and Towns
- Published online:
- 04 March 2010
- Print publication:
- 25 June 2009, pp 156-176
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Summary
Introduction
As discussed by Chapman and Underwood (Chapter 4), urbanisation is expanding rapidly in estuaries and along the coastlines in all continents across the world. This has led to extremely altered coastal environments, with extensive loss, fragmentation and replacement of natural habitats by built structures (e.g. Mann,1988; Walker, 1988; Glasby and Connell, 1999). Intertidal habitats, which form the interface between the land and the sea, are most strongly affected by urbanisation, because they are frequently disturbed by commercial and recreational activities (e.g. Iannuzzi et al., 1996), or extremely altered by the desire for ‘waterfront’ developments and the need to access the water from the land for transport and travel (e.g. Yapp, 1986).
Intertidal mangroves (Young and Harvey, 1996) and saltmarshes (Zedler, 1988) have received most attention with respect to urban development because their loss is immediately obvious and because they can provide habitat for rare or endangered plants or charismatic vertebrates (Zedler, 1993). Intertidal and freshwater wetlands suffered particularly severe loss and fragmentation over many years because they were considered wastelands and, thus, ‘reclaimed’ for urban development. Fortunately, in some parts of the world, this process is being reversed by active programmes of mitigation and restoration (Zedler et al., 1998).
Similarly, changes to subtidal seagrass meadows have received attention because of their perceived value as nursery grounds for commercially important fish and crustaceans (Robertson and Duke, 1987; Haywood et al., 1995). In many urbanised estuaries, seagrasses have declined because of overgrowth by algae (Short and Burdick, 1996).
Effects of short-term rain events on mobile macrofauna living on seawalls
- David J. Blockley, Victoria J. Cole, Julie People, M. Gabriela Palomo
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- Journal:
- Journal of the Marine Biological Association of the United Kingdom / Volume 87 / Issue 5 / October 2007
- Published online by Cambridge University Press:
- 18 October 2007, pp. 1069-1074
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The distribution and abundance of intertidal organisms can be affected by short-term events, such as rain. We compared the effects of rain on intertidal mobile invertebrates in four common microhabitats with differing amounts of shelter (namely beds of oysters, coralline turf, bare patches and crevices) on sea walls in Sydney Harbour. There was an effect of rain on some, but not all taxa, although this was not consistent between locations or times. Effects of rain were observed for some species of gastropods and crustaceans, but not for polychaetes. Manipulative experiments using artificial rain indicated that rain, without the presence of run-off and independent of potential temporal confounding from differences in weather conditions, has a negative effect on abundances of amphipods in coralline turf. Pulse responses by mobile organisms to short-term rain events should be considered when designing experiments looking at temporal variability and processes responsible for observed patterns of distribution of marine organisms.