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From the Cousins Center for Psychoneuroimmunology (J.E.B.), UCLA Neuropsychiatric Institute, the Department of Psychiatry and Biobehavioral Sciences (J.E.B.), David Geffen School of Medicine at UCLA, the Division of Cancer Prevention and Control Research (J.E.B., P.A.G.), Jonsson Comprehensive Cancer Center at UCLA, UCLA Schools of Medicine and Public Health (P.A.G.), and UCLA Department of Pathology and Laboratory Medicine (N.A.), Los Angeles, CA.
Address correspondence and reprint requests to Julienne E. Bower, PhD, UCLA Cousins Center for Psychoneuroimmunology, 300 UCLA Medical Plaza, Room 3306, Box 957076, Los Angeles, CA 90095-7076. E-mail: jbower{at}ucla.edu
Objective: Fatigue is one of the most common and distressing symptoms experienced by cancer patients and survivors. However, the etiology of cancer-related fatigue has not been determined. In previous studies, we have shown alterations in morning serum cortisol levels and diurnal cortisol rhythms in fatigued breast cancer survivors compared with nonfatigued control subjects. The purpose of the current study was to evaluate cortisol responses to an experimental psychologic stressor in fatigued and nonfatigued survivors.
Methods: Participants included 27 breast cancer survivors (11 fatigued, 16 nonfatigued). All had completed cancer treatment at least 3 years previously and were currently healthy with no evidence of recurrence. A standardized laboratory stressor, the Trier Social Stress Test (TSST), was administered during a 90-minute afternoon session. Saliva samples and autonomic measures (heart rate, blood pressure) were collected at 15-minute intervals throughout the session.
Results: Fatigued survivors showed a significantly blunted cortisol response to the stressor compared with nonfatigued survivors, controlling for depression and other potential confounds (p <.05). No differences in autonomic measures were observed.
Conclusions: These results, together with our earlier findings, suggest a dysregulation in hypothalamic–pituitary–adrenal (HPA) axis responsiveness among breast cancer survivors with enduring fatigue. Although the sample size was small, results suggest that attention to the HPA axis may be important for understanding cancer-related fatigue.
Key Words: breast cancer • fatigue • HPA axis • psychologic stress
Abbreviations: BDI = Beck Depression Inventory; HPA = hypothalamic–pituitary–adrenal; TSST = Trier Social Stress Test.
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