Life stress as a risk factor for sustained anxiety and cortisol dysregulation during the first year of survivorship in ovarian cancer.

Autor: Armer JS; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa., Clevenger L; Department of Psychiatry, University of Iowa, Iowa City, Iowa., Davis LZ; Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan., Cuneo M; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa., Thaker PH; Gynecologic Oncology, Obstetrics and Gynecology, Washington University School of Medicine, St Louis, Missouri., Goodheart MJ; Gynecologic Oncology, Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa., Bender DP; Gynecologic Oncology, Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa., Dahmoush L; Department of Pathology, University of Iowa, Iowa City, Iowa., Sood AK; Gyneclogic Oncology, Cancer Biology, and Center for RNA Interference and Noncoding RNA, The University of Texas MD Anderson Cancer Center, Houston, Texas., Cole SW; Hematology/Oncology, David Geffen School of Medicine, and the Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, California., Slavich GM; Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA., Lutgendorf SK; Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa.; Gynecologic Oncology, Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.; Department of Urology, University of Iowa, Iowa City, Iowa.
Jazyk: angličtina
Zdroj: Cancer [Cancer] 2018 Aug; Vol. 124 (16), pp. 3401-3408. Date of Electronic Publication: 2018 Jun 15.
DOI: 10.1002/cncr.31570
Abstrakt: Background: Patients with ovarian cancer often report elevated anxiety at diagnosis that decreases posttreatment. However, a minority of patients experience sustained anxiety. Few studies have examined risk factors for persistent anxiety or its physiologic sequelae in ovarian cancer. Therefore, the authors investigated associations between prior life events, anxiety, inflammation (plasma levels of interleukin-6), and diurnal cortisol profiles in patients with ovarian cancer during the first year postdiagnosis.
Methods: Participants (n = 337) completed surveys and had blood and salivary sampling prediagnosis, postchemotherapy (6 months), and 12 months after diagnosis. The Life Events and Difficulties Schedule was administered to a patient subset (n = 127) within 1 month of diagnosis. Linear mixed-effects models were used to analyze relations between anxiety and biologic variables over time. Linear regression models assessed whether anxiety trajectories mediated associations between prior stress exposure and biologic variables. Age, chemotherapy at 1 year, and cancer stage were covariates.
Results: Decreased anxiety was associated with a more normalized cortisol slope over time (β = 0.092; P = .047). Early life adversity was related to flatter cortisol slopes over time (β = -0.763; P = .002); this relation was partially mediated by anxiety trajectory (P = .046). More danger-related events prediagnosis were associated with sustained anxiety (β = 0.537; P = .019) and flatter cortisol slopes over time (β = -0.243; P = .047); anxiety partially mediated the relation between danger and cortisol slope (P = .037). Neither anxiety nor prior stress exposure was related to levels of interleukin-6.
Conclusions: Because dysregulated cortisol has been related to fatigue, poorer quality of life, and shorter survival in patients with ovarian cancer, those who have prior life events and chronic anxiety during the first year postdiagnosis may be at risk for more negative outcomes. Cancer 2018. © 2018 American Cancer Society.
(© 2018 American Cancer Society.)
Databáze: MEDLINE
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