Abstract
BACKGROUND: The pathophysiology of fear of cancer recurrence (FCR), the leading unmet psychological need of cancer survivors, may involve the dysfunctional processing of fear memory. n-3 polyunsaturated fatty acids (PUFAs) have beneficial effects on psychiatric disorders, including depressive disorder and anxiety disorders, and are involved in fear memory processing. We hypothesized that n-3 PUFA composition is associated with FCR in cancer survivors. METHODS: We conducted a cross-sectional study to examine the relationship between n-3 PUFAs and FCR among breast cancer survivors. Adults who had been diagnosed with invasive breast cancer and were not undergoing chemotherapy were asked to participate. Blood PUFA composition was evaluated by using capillary blood. We directly administered the Concerns About Recurrence Scale (CARS) to assess the grade of FCR. RESULTS:
Among 126 participants used for the analysis, the mean age (SD) was 58 (11) years and 47% had stage I cancer. Multiple regression analysis controlling for possible confounders, depressive symptoms, and post-traumatic stress disorder (PTSD) symptoms revealed that the alpha-linolenic acid (ALA) level was significantly inversely associated with the average score on the CARS overall fear index (beta = -0.165, p = 0.04). No significant associations were found for other PUFAs. LIMITATIONS: Our findings were obtained from a cross-sectional study in a single institute. CONCLUSION: These findings provide the first evidence of a beneficial effect of ALA on FCR and indicate the need for prospective study of this association. FCR among breast cancer survivors might be controllable by prudent selection of ALA-containing cooking oil.
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Key Points
Based on a review of these previous studies and other studies suggesting that n-3 PUFA interventions might be able to ameliorate dysfunctional fear memory processing via anti inflammation/ immunomodulation or by augmenting brain-derived neurotrophic factor (BDNF) or adult neurogenesis, the authors recently proposed the hypothetical effects of n-3 PUFAs on FCR in cancer survivors. Few studies have addressed the biological risk factors of FCR, and no studies have examined the relationship between FCR and PUFAs in cancer survivors. The present study investigated the relationship between n-3 PUFAs and FCR using multivariate regression analysis controlling for possible confounders such as age and history of chemotherapy, depressive symptoms, and PTSD symptoms. The results suggests that a higher peripheral blood level of ALA is significantly associated with lower FCR, independent of depressive symptoms and cancer-related PTSD symptoms. These results indicate a beneficial effect of ALA on FCR and the possibility of a novel nutritional intervention using ALA for reducing FCR. The study failed to find the effects of cancer-related PTSD symptoms on the relationship between ALA and FCR. This result implied that the mechanism underlying the relationship between PUFAs and FCR was different from that between PUFAs and PTSD. The findings provide the first evidence of a beneficial effect of ALA on FCR. Further studies should assess the beneficial effects of PUFAs on FCR using a prospective design, such as a randomized control study. FCR among breast cancer survivors might be controllable by prudent selection of an ALA-containing products such as flaxseed.