Diurnal cortisol rhythms, fatigue and psychosocial factors in five-year survivors of ovarian cancer
Open accessAbstract
Fatigue is a challenge in ovarian cancer survivorship and greatly impacts quality of life. In other cancer populations, fatigue has been associated with abnormal diurnal cortisol patterns. However, little is known about biological and behavioral factors in 5+-year ovarian cancer survivors and potential mechanisms underlying persistent fatigue have not been investigated in this population. Moreover, relationships between neuroendocrine and psychosocial factors in 5+-year ovarian cancer survivors have not been studied. We addressed these issues by examining relationships between diurnal cortisol rhythms, fatigue, life stress, and social support in 30 survivors of ovarian cancer who were assessed at least 5 years (mean=6.20years) following their primary diagnosis. Flatter diurnal cortisol slopes were associated with higher levels of fatigue, suggesting a role for HPA-axis dysregulation in sustained fatigue experienced by survivors. Moreover, greater cumulative lifetime stressor exposure (p=0.023) and stressor severity (p=0.004) were associated with flatter diurnal cortisol slopes, while higher social attachment (p=0.001) was associated with steeper diurnal cortisol slopes. These findings suggest that ovarian cancer survivors with greater lifetime stress exposure or lower social attachment may be at increased risk for circadian rhythm disruption, which in turn is associated with fatigue. Future research should examine relationships of clinical stage and inflammatory cytokines to cortisol rhythms and fatigue in long-term ovarian cancer survivors, as well as investigating the clinical significance of abnormal diurnal cortisol profiles in this population.
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Higher Adult STRAIN scores have been associated with worse mental and physical health and poorer cognitive, biological, and clinical functioning across several studies and health contexts.
“Higher Adult STRAIN scores have also been associated with worse mental and physical health, as well as poorer cognitive, biological, clinical functioning across several different studies and distinct health contexts (e.g., Bower et al. 2014; Cuneo et al. 2017; Dooley et al. 2017; Goldfarb et al. 2017; Lam et al. 2019; Shields et al. 2017a, b; Slavich and Shields 2018; Toussaint et al. 2016).”
From Life stress and suicide in adolescents (2019) · cites this paper as Cuneo et al. 2017
The STRAIN has previously been validated against health-relevant biomarkers.
“we have previously validated the STRAIN against health-relevant biomarkers (27,28,30)”
From Assessing Lifetime Stress Exposure Using the Stress and Adversity Inventory for Adults (Adult STRAIN): An Overview and Initial Validation (2018) · cites this paper as [30]
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- Authors
- Cuneo, M. G., Schrepf, A., Slavich, G. M., Thaker, P. H., Goodheart, M., Bender, D., Cole, S. W., Sood, A. K., & Lutgendorf, S. K.
- Affiliations
- University of Iowa (US)
- University of Michigan (US)
- University of California, Los Angeles (US)
- Washington University in St. Louis (US)
- The University of Texas MD Anderson Cancer Center (US)
- Corresponding author
- Lutgendorf, Susan K.
- ORCID
- Venue
- Psychoneuroendocrinology
- Publisher
- Elsevier BV
- Published
- 2017-10
- Volume
- 84
- Pages
- 139-142
- ISSN
- 0306-4530 (ISSN-L)
- PMC
- PMC5575993
- OpenAlex
- W2731138358
- Cited by
- 55
- References
- 16
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 6 · 2023: 2 · 2022: 9 · 2021: 5 · 2020: 8 · 2019: 6 · 2018: 4 · 2017: 2
- FWCI
- 2.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychoneuroendocrinology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (T32 GM108540, CA193249, CA140933, CA104825, CA109298)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- ovarian cancer survivors, cancer-related fatigue, diurnal cortisol rhythm, HPA axis dysregulation, life events, social support, social attachment, circadian rhythm disruption, psychosocial factors, neuroendocrine factors
- MeSH terms
- Circadian Rhythm, Depression, Fatigue, Female, Humans, Hydrocortisone, Ovarian Neoplasms, Psychology, Quality of Life, Saliva, Social Support, Stress, Psychological, Survivors
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