Kelly A. Biegler

Longitudinal Change in Telomere Length and the Chronic Stress Response in a Randomized Pilot Biobehavioral Clinical Study: Implications for Cancer Prevention

Shortened telomere length is associated with increased cancer incidence and mortality. Populations experiencing chronic stress have accelerated telomere shortening. In this exploratory study, we examined associations between longitudinal changes in patient reported outcomes (PRO) of psychologic distress and peripheral blood mononuclear cell (PBMC) telomere length to test the hypothesis that modulation of the chronic stress response would also modulate telomere dynamics. Archived PBMC specimens (N = 22) were analyzed from a completed and reported randomized, longitudinal trial that showed a psychosocial telephone counseling intervention improved quality of life (QOL) and modulated stress-associated biomarkers in cervical cancer survivors. PROs and biospecimens were collected at baseline and 4 months postenrollment. Telomere length of archived PBMCs was evaluated using the flow-FISH assay. Longitudinal changes in psychologic distress, measured by the Brief Symptom Inventory-18, were significantly associated with increased telomere length within the CD14+ (monocyte) population (r = −0.46, P = 0.043); a similar trend was observed for the CD14− population. Longitudinal changes in telomere length of the CD14− subset, primarily T lymphocytes, were associated with longitudinal increases in the naive T-cell population (r = 0.49, P = 0.052). Alterations in the chronic stress response were associated with modulation of telomere length in PBMCs, with evidence for mobilization of “younger” cells from progenitor populations. These data provide preliminary support for the (i) capacity to modulate the chronic stress response and the associated accelerated telomere shortening, (ii) inclusion of telomere length in the biobehavioral paradigm, and (iii) potential link between the chronic stress response and biologic mechanisms responsible for genomic integrity and carcinogenesis. Cancer Prev Res; 5(10); 1173–82. ©2012 AACR.

The Role of Religion and Spirituality in Psychological Distress Prior to Surgery for Urologic Cancer

The present study examined the associations between religion and spirituality (R/S), presurgical distress, and other psychosocial factors such as engagement coping, avoidant coping, and social support. Participants were 115 men scheduled for surgery for urologic cancer. Before surgery, participants completed scales measuring intrinsic religiosity, organized religious activity, and nonorganized religious activity (IR, ORA, NORA); social support (Medical Outcomes Study Social Support Survey); and distress (Impact of Event Scale [IES], Perceived Stress Scale [PSS], Brief Symptom Inventory-18 [BSI-18], and Profile of Mood States [POMS]). R/S was positively associated with engagement coping. Social support was positively associated with engagement coping and inversely associated with POMS and PSS scores. Engagement coping was positively associated with IES and BSI scores, and avoidant coping was positively associated with all distress measures. R/S moderated the association between engagement coping and IES scores, such that the association between engagement coping and IES was not significant for men with high R/S scores (greater religious belief). R/S moderated the association between social support and distress; the inverse association between social support and PSS and POMS scores was only significant for men who scored high on R/S. This study replicated findings from previous studies suggesting that engagement and avoidant types of coping can lead to increased distress prior to surgery. Although R/S was associated with engagement coping, it was not associated with any of the distress measures. The finding that R/S moderated the associations between engagement coping and distress and social support and distress suggests that the association between R/S, coping style, social support, and adjustment to stressful life situations is not simplistic, and indirect associations should be explored.

Differences in Self-Reported Physical Activity and Body Mass Index Among Older Hispanic and Non-Hispanic White Men and Women: Findings from the 2009 California Health Interview Survey

Older Hispanic Americans are a rapidly growing minority group who are disproportionately affected by diabetes mellitus and obesity. Given the importance of physical activity, particularly leisure‐time activity, in the management of diabetes mellitus and obesity, the current study examined ethnic and sex differences in walking for transportation, leisure‐time walking, moderate activity (not including walking), and vigorous activity between Hispanic and non‐Hispanic white (NHW) older adults (age 55 and older) using the 2009 California Health Interview Survey, a population‐based survey representative of Californias noninstitutionalized population. The total sample consisted of 21,702 participants (20,148 NHW (7,968 men, 12,180 women) and 1,554 Hispanic (609 men, 945 women)). Multivariable logistic and linear regression analyses were adjusted for sociodemographic characteristics. The findings revealed that Hispanic men and women were significantly less likely to engage in self‐reported leisure‐time walking and vigorous activity than NHW men (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.51–0.99) and women (aOR = 0.60, 95% CI = 0.42–0.87). Regardless of ethnic group, men were more likely than women to engage in self‐reported walking for transportation (aOR = 0.71, 95% CI = 0.58–0.87), moderate activity (aOR = 0.68, 95% CI = 0.57–0.81), and vigorous activity (aOR = 0.58, 95% CI = 0.50–0.68). All types of self‐reported physical activity were associated with lower body mass index (BMI; P < .001), although significant interactions between sex and leisure time walking (P < .001), moderate activity (P < .001), and vigorous activity (P < .001) indicated that women who engaged in these activities reported the lowest BMIs. The findings highlight the importance of emphasizing walking in efforts to increase moderate and vigorous activity, particularly for older women.

Unidas por La Vida (United for Life): Implementing A Culturally- Tailored, Community- Based, Family-Oriented Lifestyle Intervention

Unidas por la Vida, a behavioral weight-loss program, was developed for use among low-income, Mexican-American women with diabetes and their overweight/obese adult daughters. The program leverages community resources in a partnership between primary care and community-based organizations. This paper describes the programs implementation, lessons learned, and implications for sustainability.

Barriers to Mental Health Care for an Ethnically and Racially Diverse Sample of Older Adults

This study examined potential barriers to mental healthcare use of older adults from diverse ethnic and racial backgrounds.

Mind–Body Research in Cancer

Mind-body practices are defined as a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms. A large percentage of the population, and especially people with cancer, participate in mind-body programs to help relieve stress, improve quality of life, and modulate physiological systems. At The University of Texas M. D. Anderson Cancer Center, we are conducting a number of clinical trials examining the biobehavioral effects of mind-body programs such as Tibetan Yoga, Hatha Yoga, meditation, and Qigong. Initial studies have found that these programs help to improve aspects of patient quality of life during and after treatment. More research is needed in this area with the use of appropriate control groups and thorough examination of the potential mediators of the benefits of the interventions to truly know the efficacy of these programs. It is clear that different mind-body practices have their place in oncology care. However, it is still uncertain which programs are most effective, and it will likely turn out that different programs are useful for different people at different times within the treatment and recovery trajectory. The key for health care professionals and patients is to encourage participation in some type of mind-body program to help improve aspects of quality of life.

Rationale and study protocol for Unidas por la Vida (United for Life): A dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters

BACKGROUND Half of Mexican-American women are under-active and nearly 78% are overweight/obese. The high lifetime risk of developing type 2 diabetes necessitates a culturally appropriate lifestyle intervention. PURPOSE Unidas por la Vida is a novel dyadic intervention that capitalizes on the centrality of family in Latino culture to mobilize an existing family dyad as a resource for health behavior change. The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. METHODS Participants (N = 460 mother-adult daughter dyads) will be randomized into one of three conditions: 1) dyadic participation (mothers-daughters) in a lifestyle intervention; 2) individual participation (mothers alone; unrelated daughters alone) in a lifestyle intervention; and 3) mother-daughter dyads in a minimal intervention control group. RESULTS The primary outcome is weight loss. Secondary outcomes include physical activity, dietary intake, physiological measures (e.g. HbA1c), and body composition. Both the dyadic and individual interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group, with women assigned to the dyadic intervention expected to lose more weight and to maintain the weight loss longer than women assigned to the individual intervention. CONCLUSION Because health risks are often shared by multiple members of at-risk families, culturally appropriate, dyadic interventions have the potential to increase the success of behavior change efforts and to extend their reach to multiple family members. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT02741037.

Abstract 1833: Longitudinal associations between telomere length, chronic stress, and immune stance in cervical cancer survivors

Proceedings: AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011; Orlando, FL Introduction: There is a growing recognition of a potential role of chronic psychological stress in increasing the rate of cancer development and growth; however, potential mechanisms remain poorly understood and under active investigation. Recently, accelerated telomere shortening has been observed in cross sectional studies of non-cancer populations experiencing chronic stress suggesting a potential link between chronic stress and genomic integrity thus, raising the possibility that modulation of stress might affect telomere dynamics. We examined archived peripheral blood mononuclear cell (PBMC) samples collected in a longitudinal randomized study evaluating a psychosocial telephone counseling (PTC) intervention to improve cervical cancer patient coping and hence stress, as measured by improvement in quality of life (QOL), and stress-associated biomarkers (Clin Cancer Res 14(7): 2111-18). In this pilot study, we examined the longitudinal associations between telomere length, QOL, and immunologic stance in this cohort obtaining data in support of the above hypothesis. Methods: Archived PBMC specimens were analyzed from a completed randomized trial that demonstrated PTC associated improvement in QOL and an association between improved QOL and a shift to a more prominent Th1 immunologic stance. Briefly, QOL data (FACT-Cx and BSI) and biospecimens were collected at baseline and four months after enrollment (N = 31). Telomere length of archived PBMCs, T cells (including CD4 and CD8 subsets), B cells (CD19) and monocytes (CD14) were examined using the Flow-FISH assay. Results: Longitudinal changes in the Physical Well-Being subscale of the FACT-Cx were significantly associated with increased telomere length within the total PBMC population (r=0.799, p=0.031); the FACT-CX score showed a borderline association, likely due to the fact no other FACT subscales were associated with longitudinal changes in telomere length. Improved BSI scores showed a similar, although non-significant trend. The observed shift toward a Th1 immune stance in subjects with improved QOL were correlated with increased telomere length in CD4 (r=0.810; p=0.027) and CD8 (r=0.705; p=0.075) cellular subsets; however, no significant associations were observed between a more pronounced Th1 stance and CD14 or CD19 subsets. The finding of a longitudinal increase in telomere length in circulating PBMCs is not without precedent as this has been observed in several murine models Discussion: This is the first study of longitudinal changes in telomere length associated with immune profile and QOL as an index of chronic stress and has provocative implications for the association between the psychoneuroimmune axis, telomere dynamics, genomic stability, and cancer survivorship outcomes. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 1833. doi:10.1158/1538-7445.AM2011-1833