A Conceptual Model of Psychoneurological Symptom Cluster Variation in Women with Breast Cancer: Bringing Nursing Research to Personalized Medicine
Angela R. Starkweather, Debra E. Lyon, R. K. Elswick, Alison J. Montpetit, Yvette Conley and Nancy L. McCain
Affiliation: Department of Adult Health and Nursing Systems, Virginia Commonwealth University School of Nursing. 1100 East Leigh Street, P. O. Box 980567; Richmond, VA 23298, USA.
Personalized medicine applies knowledge about the patient’s individual characteristics in relation to health and
intervention outcomes, including treatment response and adverse side-effects, to develop a tailored treatment plan. For
women with breast cancer, personalized medicine has substantially improved the rate of survival, however, a high
proportion of these women report multiple, co-occurring psychoneurological symptoms over the treatment trajectory that
adversely affect their quality of life. In a subset of these women, co-occurring symptoms referred to as symptoms clusters,
can persist long after treatment has ended. Over the past decade, research from the field of nursing and other health
sciences has specifically examined the potential underlying mechanisms of the psychoneurological symptom cluster in
women with breast cancer. Recent findings suggest that epigenetic and genomic factors contribute to inter-individual
variability in the experience of psychoneurological symptoms during and after breast cancer treatment. While nursing
research has been underrepresented in the field of personalized medicine, these studies represent a shared goal; that is, to
improve patient outcomes by considering the individual’s risk of short- and long-term adverse symptoms. The aim of this
paper is to introduce a conceptual model of the individual variations that influence psychoneurological symptoms in
women with breast cancer, including perceived stress, hypothalamic-pituitary adrenocortical axis dysfunction,
inflammation, as well as epigenetic and genomic factors. The proposed concepts will help bring nursing research and
personalized medicine together, in hopes that this hitherto neglected and understudied area of biomedical research
convergence may ultimately lead to the development of more targeted clinical nursing strategies in breast cancer patients
with psychoneurological symptoms.
Keywords: Breast cancer, epigenetics, genetics, hypothalamic-pituitary-adrenal axis, personalized medicine, psychoneuroimmunology,
psychoneurological symptoms, symptom clusters.
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