Diurnal cortisol dysregulation, functional disability, and depression in women with ovarian cancer

Authors

  • Aliza Z. Weinrib MA,

    1. Department of Psychology, University of Iowa, Iowa City, Iowa
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  • Sandra E. Sephton PhD,

    1. Department of Psychological and Brain Sciences and James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
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  • Koen DeGeest MD,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
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  • Frank Penedo PhD,

    1. Department of Psychology, University of Miami, Coral Gables, Florida
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  • David Bender MD,

    1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
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  • Bridget Zimmerman PhD,

    1. Biostatistical Consulting Center, College of Public Health, University of Iowa Health Care, Iowa City, Iowa
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  • Clemens Kirschbaum PhD,

    1. Department of Biological Psychology, Technical University of Dresden, Dresden, Germany
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  • Anil K. Sood MD,

    1. Department of Gynecologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    2. Department of Cancer Biology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • David M. Lubaroff PhD,

    1. Department of Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
    2. Department of Microbiology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
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  • Susan K. Lutgendorf PhD

    Corresponding author
    1. Department of Psychology, University of Iowa, Iowa City, Iowa
    2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
    3. Department of Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
    • Departments of Psychology, Obstetrics and Gynecology, and Urology and Holden Comprehensive Cancer Center, University of Iowa, E11 Seashore Hall, Iowa City, IA 52242
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    • Fax: (319) 335-0191


Abstract

BACKGROUND:

Multiple alterations in circadian rhythms have been observed in cancer patients, including the diurnal rhythm of the adrenal hormone cortisol. Diurnal cortisol alterations have been associated with cancer-related physiological processes as well as psychological stress. Here we investigate alterations in diurnal cortisol rhythm in ovarian cancer patients, and potential links with depression, life stress, and functional disability.

METHODS:

Women (n = 177) with suspected ovarian cancer completed questionnaires and collected salivary cortisol 3× daily for 3 consecutive days before surgery. One hundred women were subsequently diagnosed with ovarian cancer and 77 with benign disease. In addition, healthy women (n = 33) not scheduled for surgery collected salivary cortisol at the same time points.

RESULTS:

Ovarian cancer patients demonstrated significantly elevated nocturnal cortisol (P = .022) and diminished cortisol variability (P = .023) compared with women with benign disease and with healthy women (all P values <.0001). Among ovarian cancer patients, higher levels of nocturnal cortisol and less cortisol variability were significantly associated with greater functional disability, fatigue, and vegetative depression, but not with stress, distress, or depressed affect. There were no significant associations between functional or psychological variables and diurnal cortisol in women with benign disease.

CONCLUSIONS:

Nocturnal cortisol and cortisol variability show significant dysregulation in ovarian cancer patients, and this dysregulation was associated with greater functional disability, fatigue, and vegetative depression. These findings suggest potential hypothalamic-pituitary-adrenal involvement in functional disability in ovarian cancer, and may have implications for disease progression. Cancer 2010. © 2010 American Cancer Society.

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