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Endocrine Levels at the Start of Treatment Are Associated With Subsequent Psychological Adjustment in Cancer Patients With Metastatic Disease

From the Department of Behavioral Science (L.C., C.D., D.D.), The University of Texas M. D. Anderson Cancer Center, Houston, TX; Behavioral Medicine and Oncology (A.B.), University of Pittsburgh Cancer Institute, Pittsburgh, PA; and Department of Urology (R.J.A.), Baylor College of Medicine, Houston, TX.

Address reprint requests to: Lorenzo Cohen, PhD, Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 243, Houston, TX 77030. Email: lcohen{at}mdanderson.org

OBJECTIVE: This study examined the association between hormonal profiles at the start of cancer treatment and subsequent psychological symptomatology.

METHODS: Twenty-seven patients with metastatic renal cell carcinoma and 18 patients with metastatic melanoma completed three assessments during the course of treatment: at the start of treatment (baseline), at the end of treatment (3 weeks after baseline), and at a follow-up appointment 1 month later. Cortisol, norepinephrine, and epinephrine levels were measured at baseline using 15-hour urine samples. At each assessment, patients completed the Impact of Event Scale (IES) and the Brief Symptom Inventory (BSI).

RESULTS: Patients reported moderate levels of distress throughout treatment as measured by the IES and BSI. Norepinephrine levels at the start of treatment were positively associated with IES total scores at the end of treatment and at follow-up, and cortisol levels were positively associated with IES total scores at follow-up after adjusting for baseline IES and overall distress scores. Norepinephrine levels were also positively associated with depression scores at follow-up, and cortisol levels were positively associated with depression scores at the end of treatment and at follow-up after adjusting for baseline depression and overall distress scores.

CONCLUSIONS: Hormonal profiles at the start of cancer treatment are associated with subsequent psychological adjustment.

Key Words: cortisol, • norepinephrine, • depression, • intrusive thoughts, • cancer.

Abbreviations: BSI = Brief Symptom Inventory;; GSI = Global Severity Index;; HPA = hypothalamic-pituitary-adrenal (axis);; IES = Impact of Event Scale;; MDD = major depressive disorder;; MVA = motor vehicle accident;; PTSD = posttraumatic stress disorder;; SNS = sympathetic nervous system.

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