Journal article
Life stress as a risk factor for sustained anxiety and cortisol dysregulation during the first year of survivorship in ovarian cancer
Cancer, Vol.124(16), pp.3401-3408
08/15/2018
DOI: 10.1002/cncr.31570
PMCID: PMC6108904
PMID: 29905941
Abstract
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. Associations between prior life stressors, anxiety, inflammation, and diurnal cortisol profiles are investigated in patients with ovarian cancer. The results indicate that early life stress and adulthood stressors involving danger contribute to persistent anxiety and dysregulated cortisol patterns during the first year after ovarian cancer diagnosis.
Details
- Title: Subtitle
- Life stress as a risk factor for sustained anxiety and cortisol dysregulation during the first year of survivorship in ovarian cancer
- Creators
- Jessica S Armer - University of IowaLauren Clevenger - University of IowaLauren Z Davis - Veterans Affairs Ann Arbor Healthcare SystemMichaela Cuneo - University of IowaPremal H Thaker - Washington University School of MedicineMichael J Goodheart - University of IowaDavid P Bender - University of IowaLaila Dahmoush - University of IowaAnil K Sood - The University of Texas MD Anderson Cancer CenterSteven W Cole - University of CaliforniaGeorge M Slavich - University of CaliforniaSusan K Lutgendorf - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Cancer, Vol.124(16), pp.3401-3408
- DOI
- 10.1002/cncr.31570
- PMID
- 29905941
- PMCID
- PMC6108904
- NLM abbreviation
- Cancer
- ISSN
- 0008-543X
- eISSN
- 1097-0142
- Number of pages
- 9
- Grant note
- National Institutes of Health (CA193249; CA140933; CA109298; AG017265; AG043404; MH103443; P30CA086862)
- Language
- English
- Date published
- 08/15/2018
- Academic Unit
- Psychiatry; Psychological and Brain Sciences; Pathology; Iowa Neuroscience Institute; Obstetrics and Gynecology; Urology
- Record Identifier
- 9983931810902771
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