br Our primary analyses used linear regression to quantify associations
Our primary analyses used linear regression to quantify associations between the magnitude of change in eudaimonic well-being and the magnitude of change in the global CTRA score. Significant bivariate associations were followed up with covariate-adjusted analyses con-trolling for age, BMI, time since cancer diagnosis, tumor stage, and use of endocrine therapy. To further interrogate the specificity of this KRN 7000 as-sociation, we also tested whether this association held when simulta-neously controlling for change in hedonic well-being. Secondary ana-lyses were then conducted to examine whether increases in hedonic well-being alone were associated with the magnitude of change in the global CTRA score, and whether decreases in depressive symptoms alone were associated with the magnitude of change in the global CTRA score.
3.1. Sample characteristics
Women endorsed feelings of eudaimonic well-being two-to-three times a week over the past month (M = 3.11, SD = 1.01), with levels of
Demographic, Medical and Treatment-Related Characteristics of the Sample.
Employed full or part-time
Homemaker/volunteer 7 (32%)
Current endocrine therapy 9 (41%)
Note: M = mean; SD = standard deviation.
hedonic well-being in a similar range (M = 3.51, SD = 1.06). These levels of well-being are comparable to those observed in non-clinical samples (Lamers et al., 2010). Depressive symptoms were elevated at baseline; mean scores on the CES-D (M = 15.50; SD = 10.68; range 1–40) were comparable to other samples of younger breast cancer survivors (Ganz et al., 2012), including those in our previous inter-vention study (Bower et al., 2015). Of note, 55% endorsed clinically significant depressive symptoms, as indicated by CES-D scores greater than or equal to a 16.
3.2. Preliminary analyses: Intervention-associated changes in well-being, depressive symptoms, and gene expression
Paired samples t-tests demonstrated significant changes in well-being and depressive symptoms from pre to post-intervention (see Table 2). More specifically, there was a significant increase in eu-daimonic well-being (t(20) = 3.23, p = 0.004, d = 0.71) and hedonic well-being (t(20) = 2.16, p = .043, d = 0.47). Depressive symptoms decreased significantly after the intervention, (t(21) = −2.97, p = .007, d = 0.63), with an effect size similar to that observed in our previous RCT (d = .54; Bower et al., 2015). See Table 3 for correlations among psychosocial measures. In genome-wide transcriptional profiling of peripheral blood monocytes, there was no significant change from pre- to post-inter-vention in average expression of a 53-gene CTRA composite score
Table 2 r> Pre- and Post-Intervention Means and Standard Deviations for Eudaimonic Well-Being, Hedonic Well-Being, and Depressive Symptoms.
Outcome Mean SD Mean SD p value Cohen’s d
Correlations for Eudaimonic Well-Being, Hedonic Well-Being, and Depressive Symptoms.
Note: T1 = Pre-intervention; T2 = Post-intervention.
(−0.046 ± .042, p = .274). However, analyses verified the previously observed effects of the MAPs intervention on reducing expression of the 19-gene pro-inflammatory subcomponent of the CTRA score (mean changen = −.084 log2 mRNA expression units ± 0.030 SE, p = .013; Bower et al., 2015). Consistent with the observed decrease in the a priori-specified pro-inflammatory composite score, ancillary analyses of all 78 genes that empirically showed 1.15-fold change in average ex-pression from pre- to post-intervention (15 up-regulated and 63 down-regulated) indicated decreased activity in NF-κB/Rel family transcrip-tion factors (0.34-fold ratio of binding sites in up- vs. down-regulated genes: log2 ratio = −1.56 ± 0.60, p = .010), consistent with our earlier trial (Bower et al., 2015). Further, Transcript Origin Analyses identified pro-inflammatory CD16- “classical monocytes” as the pri-mary cellular origin of down-regulated gene transcripts (cell diag-nosticity score: 0.66 ± 0.27, p = .009).