Isotretinoin

This project combined data from two pilot studies with largely parallel designs involving married or partnered female patients. Sample 1 consisted of 13 women with RA (mean age: 56 years, SD = 13, mean disease duration: 6.9 years, SD = 4.3; education: at least bachelor’s degree: n = 5). Sample 2 consisted of 21 women with BC undergoing radiation or chemotherapy (mean age: 57 years, SD = 13; mean time since date of initial diagnosis: 2.3 years, SD = 2.4; education: at least bachelor’s degree: n = 16).
In both samples, participants wore the Electronically Activated Recorder (EAR; Mehl, Pennebaker, Crow, Dabbs, & Price, 2001 ; Mehl, Vazire, Ramírez-Esparza, Slatcher, & Pennebaker, 2007 (link)), an observational ecological momentary assessment tool that periodically samples ambient sounds from participants’ moment-to-moment social environments, on weekends during their waking hours. Recruited from a larger study (Kasle, Wilhelm, & Zautra, 2008 (link)), the 13 women with RA participated in two EAR monitorings separated by one month (Robbins, Mehl, Holleran & Kasle, in press ), and a four-month follow-up. The 21 women with BC were recruited at the Arizona Cancer Center and participated in one EAR monitoring and a two-month follow-up (Figure 1).
The EAR consisted of a small handheld computer (Dell Axim X50) with recording software and a lapel microphone. In the RA sample, the EAR recorded 50 s every 18 min and yielded on average 224 waking sound files per participant over both weekends (SD = 33). In the BC sample, it recorded 50 s every 9 min and yielded on average 177 waking sound files per participant over one weekend (SD = 50). After debriefing, participants were given the opportunity to review their recordings and erase parts they preferred to remain private. One RA participant deleted one sound file.
Participants with RA completed the brief COPE (Carver, 1997 (link)) at each session they received the EAR. They also completed the Center for Epidemiological Studies-Depression scale (CES-D; Hann, Winter, & Jacobsen, 1999 (link); alpha = .95), pain ratings for the past month (0–100 = no-worst pain), and number of flare days over the past 6 months at the initial session (one month before the 1^st EAR weekend) and four months after the 2^nd EAR weekend (Figure 1).
Participants with BC completed the full COPE (Carver, Scheier, & Weintraub, 1989 (link)), the CES-D (alpha = .86), and the SF-36 bodily pain item (over the past 4 weeks) when they received the EAR and at the two-month follow-up (Figure 1). Changes in reported emotional support (brief COPE and COPE: “I get sympathy and understanding from someone;” “I get emotional support from others.”) and depressive symptoms (CES-D: “I felt depressed.”) were computed by residualizing follow-up for baseline scores.
Verbatim transcripts of the sound files were analyzed using the swearing category of Linguistic Inquiry and Word Count (e.g. “crap,” “hell,” “shit;” Pennebaker, Francis, & Booth, 2001 ). Separate measures of swearing in the presence of others and swearing alone were derived from only those transcripts in which participants were with others and alone (Descriptives in Table 1). All swearing variables were log transformed (using log base 10) to reduce their positive skew and improve normality. For metric comparability, all variables were standardized within-sample prior to analyses.

Patients received ch14.18 at a dose of 25 mg per square meter per day for 4 consecutive days during each of five consecutive 4-week cycles. During the last 2 weeks in each of the five cycles, they also received isotretinoin at a dose of 160 mg per square meter per day (see the immunotherapy schedule in Fig. S1A in the Supplementary Appendix); this dose of isotretinoin was also given by itself during a final sixth cycle. During cycles 1, 3, and 5, GM-CSF (Leukine, Berlex) was given daily at a dose of 250 μg per square meter per day for 14 days, starting 3 days before ch14.18 was started (Fig. S1B in the Supplementary Appendix). During cycles 2 and 4, interleukin-2 (Proleukin, Chiron) was given, by means of continuous infusion, for 4 days during week 1 at a dose of 3.0×10⁶ IU per square meter per day, as well as for 4 days during week 2 at a dose of 4.5×10⁶ IU per square meter per day, concurrent with ch14.18 (Fig. S1C in the Supplementary Appendix).