Differences in Emotional Awareness Moderate Cytokine-Symptom Associations Among Breast Cancer Survivors

Cancer survivors have elevated levels of proinflammatory cytokines, which could be associated with cancer-related symptoms. Given that proinflammatory cytokines heighten negative affect by directly affecting the brain, we explored these direct associations and whether differences in levels of emotional awareness moderate the associations between proinflammatory cytokines and cancer-related symptoms. This cross-sectional, secondary analysis of baseline data was collected from 162 female breast cancer survivors (aged 36-70 years), who were enrolled 6 ± 4 months after completing cancer treatment. We tested cytokines in serum (IL-1β, IL-6, IL-8, TNF-α, IL-4, IL-10, and TGF-β) and assessed depression, cancer-related fatigue, pain intensity, and pain interference. Emotional awareness was assessed using a performance measure, the Levels of Emotional Awareness Scale. In participants with high but not average or low levels of emotional awareness, positive associations were found for IL-1β, IL-6, and TNF-α with depression and between IL-6 and TNF-α with pain intensity. In addition, IL-6 had a positive association with pain intensity at average levels of emotional awareness. These results suggest that women with high or in some cases average, but not low, emotional awareness reported depression and pain as being positively associated with their cytokine levels. By using emotional awareness as a cognitive resource to promote emotion regulation and distress transformation, interventions may be able to counteract heightened sensitivity to the mood-altering effects of cytokines.