Cancer-related fatigue shows a stable association with diurnal cortisol dysregulation in breast cancer patients

被引：64
作者：
Schmidt, Martina E. [1 ,2 ]
Semik, Johanna [1 ,2 ]
Habermann, Nina [1 ,2 ]
Wiskemann, Joachim [3 ,4 ]
Ulrich, Cornelia M. [1 ,2 ]
Steindorf, Karen [1 ,2 ]
机构：
[1] Natl Ctr Tumour Dis NCT, Div Prevent Oncol, D-69120 Heidelberg, Germany
[2] German Canc Res Ctr, D-69120 Heidelberg, Germany
[3] Natl Ctr Tumour Dis NCT, Div Med Oncol, D-69120 Heidelberg, Germany
[4] Univ Heidelberg Hosp, Heidelberg, Germany
来源：
BRAIN BEHAVIOR AND IMMUNITY | 2016年 / 52卷
关键词：
Cortisol; Fatigue; Breast cancer; HPA axis; Circadian rhythm; RANDOMIZED CONTROLLED-TRIAL; QUALITY-OF-LIFE; GLUCOCORTICOID RESISTANCE; ADJUVANT RADIOTHERAPY; SOCIAL SUPPORT; OVARIAN-CANCER; HPA AXIS; SLEEP; DEPRESSION; WOMEN;
D O I：
10.1016/j.bbi.2015.10.005
中图分类号：
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号：
100102 ;
摘要：
Fatigue is a major burden for breast cancer patients undergoing adjuvant therapy. Yet, its pathophysiology is still not well understood. Hypothesized mechanisms include dysregulations in the hypothalamic-pituitary-adrenal (HPA) axis, which may be reflected in alterations in the diurnal cortisol patterns. However, studies on the association between cortisol and fatigue during adjuvant cancer therapy are rare. We therefore assessed salivary cortisol at awakening, 0.5 h post-awakening, noon, 5 pm and 10 pm/bedtime in 265 breast cancer patients undergoing adjuvant therapy at three timepoints. Cancerrelated fatigue was assessed with the Fatigue Assessment Questionnaire (FAQ) covering the physical, affective, and cognitive fatigue dimensions. Multiple linear regression analyses were performed cross-sectionally at the three timepoints as well as longitudinally considering changes in cortisol and fatigue over time. The results showed that the physical dimension of cancer-related fatigue was significantly associated with increased evening cortisol levels and higher overall cortisol secretion. These associations were independent of depressive symptoms. Morning cortisol levels, the cortisol awakening response and the diurnal slope were not consistently associated with physical fatigue. Affective and cognitive fatigue showed no clear association with any of the cortisol parameters. In conclusion, the physical but not the affective or cognitive dimension of fatigue seems associated with cortisol dysregulations in breast cancer patients undergoing adjuvant therapy, characterized by an unaffected cortisol level in the morning but blunted decline to the evening level. Research focusing on disturbances of the cortisol rhythm and HPA dysregulations during and after cancer treatment may open new strategies to reduce cancer-related fatigue. (C) 2015 Elsevier Inc. All rights reserved.
引用
收藏
页码：98 / 105
页数：8
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