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Dermal carotenoid measurement is inversely related to anxiety in patients with breast cancer
  1. David G Li1,
  2. Gabrielle LeCompte2,
  3. Lev Golod3,
  4. Gary Cecchi4,
  5. David Irwin4,
  6. Alden Harken5,
  7. Amy Matecki2
  1. 1 Predoctoral Clinical Research (TL1), Tufts University School of Medicine, Boston, MA, USA
  2. 2 Integrative Medicine, Highland Hospital, Oakland, CA, USA
  3. 3 University of California, Berkeley, Berkeley, CA, USA
  4. 4 Hematology and Oncology, Alta Bates Summit Medical Center, Berkeley, CA, USA
  5. 5 Surgery, Highland Hospital, Oakland, CA, USA
  1. Correspondence to David G Li, Tufts University School of Medicine, Boston, Massachusetts 02111, USA;{at}


Breast cancer is the most prevalent malignancy among women worldwide. Increased oxidative stress and poor subjective health outcomes have been associated with increased risk of cancer recurrence and metastasis, but few studies until now have explored the relationship between oxidative stress and chronic stress/anxiety. This study aims to examine the association between anxiety and a potential dermal correlate of oxidative stress in patients with breast cancer. 102 breast cancer patients were enrolled in a cross-sectional study at Highland Hospital, a county hospital in Oakland, California. Each participant’s skin carotenoid score (SCS), a potential dermal correlate of oxidative stress, was recorded via Raman spectroscopy. Patient demographics, breast cancer stage, and subjective health measures (anxiety and self-rated health) were ascertained. Multivariate linear regression analysis was performed to quantify any associations between SCS and the above health correlates. Higher levels of skin carotenoids were associated with decreased severity of anxiety, lower BMI, increased servings of vegetables/fruits in daily diet, Hispanic race, lower educational status, and nonsmoking status. Severity of anxiety as graded by the GAD-7 was inversely associated with dermal carotenoid measurements via SCS. Conclusions. Increased levels of oxidative stress as quantified by SCS is associated with greater severity of anxiety. Because chronic stress has been associated with tumor progression, increased recurrence rates, and increased metastatic risk in breast cancer,non-invasive dermal carotenoid measurements could be used as a novel objective correlate of subjective health during cancer treatment.

  • skin
  • cancer
  • anxiety
  • dermis
  • stress
  • psychological

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  • Contributors DGL and GLC initiated the collaborative project, designed data collection tools, monitored data collection for the whole trial, cleaned and analysed the data and drafted and revised the paper. They are guarantors. LG coordinated the collaborative project, monitored data collection and revised the paper with statistical input and feedback. He also wrote the statistical analysis plan, cleaned and analysed the data and revised the paper. GC monitored data collection for the trial and revised the paper. DI and AH coordinated the collaborative project, monitored data collection and revised the paper. AM initiated the collaborate project, interpreted and analysed data and revised the paper.

  • Funding The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number TL1TR001062. This project was also supported by the Research Pilot Grant from Highland Hospital, Department of Medicine.

  • Competing interests None declared.

  • Ethics approval The institutional review board of Highland Hospital in affiliation with University of California, San Francisco (UCSF) approved this cross-sectional study.

  • Provenance and peer review Not commissioned; externally peer reviewed.