© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 12, 994-1000,
June 21, 2000
© 2000 Oxford University Press
REPORTS |
Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival
Affiliations of authors: S. E. Sephton, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, KY; R. M. Sapolsky (Department of Biological Sciences), H. C. Kraemer, D. Spiegel (Department of Psychiatry and Behavioral Sciences), Stanford University, Palo Alto, CA.
Correspondence to: Sandra E. Sephton, Ph.D., Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY 40292-0001 (e-mail: sephton{at}louisville.edu).
Background: Abnormal circadian rhythms have been observed in patients with cancer, but the prognostic value of such alterations has not been confirmed. We examined the association between diurnal variation of salivary cortisol in patients with metastatic breast cancer and subsequent survival. We explored relationships between cortisol rhythms, circulating natural killer (NK) cell counts and activity, prognostic indicators, medical treatment, and psychosocial variables. Methods: Salivary cortisol levels of 104 patients with metastatic breast cancer were assessed at study entry at 0800, 1200, 1700, and 2100 hours on each of 3 consecutive days, and the slope of diurnal cortisol variation was calculated using a regression of log-transformed cortisol concentrations on sample collection time. NK cell numbers were measured by flow cytometry, and NK cell activity was measured by the chromium release assay. The survival analysis was conducted by the Cox proportional hazards regression model with two-sided statistical testing. Results: Cortisol slope predicted subsequent survival up to 7 years later. Earlier mortality occurred among patients with relatively "flat" rhythms, indicating a lack of normal diurnal variation (Cox proportional hazards, P = .0036). Patients with chest metastases, as opposed to those with visceral or bone metastases, had more rhythmic cortisol profiles. Flattened profiles were linked with low counts and suppressed activity of NK cells. After adjustment for each of these and other factors, the cortisol slope remained a statistically significant, independent predictor of survival time. NK cell count emerged as a secondary predictor of survival. Conclusions: Patients with metastatic breast cancer whose diurnal cortisol rhythms were flattened or abnormal had earlier mortality. Suppression of NK cell count and NK function may be a mediator or a marker of more rapid disease progression.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. Spiegel Losing Sleep Over Cancer J. Clin. Oncol., May 20, 2008; 26(15): 2431 - 2432. [Full Text] [PDF]
|
|
|
|
|
|
K. P. Parker, D. L. Bliwise, M. Ribeiro, S. R. Jain, C. I. Vena, M. K. Kohles-Baker, A. Rogatko, Z. Xu, and W. B. Harris Sleep/Wake Patterns of Individuals With Advanced Cancer Measured by Ambulatory Polysomnography J. Clin. Oncol., May 20, 2008; 26(15): 2464 - 2472. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 U. M. Nater, L. S. Youngblood, J. F. Jones, E. R. Unger, A. H. Miller, W. C. Reeves, and C. Heim Alterations in Diurnal Salivary Cortisol Rhythm in a Population-Based Sample of Cases With Chronic Fatigue Syndrome Psychosom Med, April 1, 2008; 70(3): 298 - 305. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Mathur, L. Duda, and D. M. Kamat Knowledge and Use of Music Therapy Among Pediatric Practitioners in Michigan Clinical Pediatrics, March 1, 2008; 47(2): 155 - 159. [Abstract] [PDF]
|
|
|
|
|
|
A. H. Miller, S. Ancoli-Israel, J. E. Bower, L. Capuron, and M. R. Irwin Neuroendocrine-Immune Mechanisms of Behavioral Comorbidities in Patients With Cancer J. Clin. Oncol., February 20, 2008; 26(6): 971 - 982. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Avers, A. Mathur, and D. Kamat Music Therapy in Pediatrics Clinical Pediatrics, September 1, 2007; 46(7): 575 - 579. [Abstract] [PDF]
|
|
|
|
|
|
D. B. Fekedulegn, M. E. Andrew, C. M. Burchfiel, J. M. Violanti, T. A. Hartley, L. E. Charles, and D. B. Miller Area Under the Curve and Other Summary Indicators of Repeated Waking Cortisol Measurements Psychosom Med, September 1, 2007; 69(7): 651 - 659. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Chen-Goodspeed and Cheng Chi Lee Tumor Suppression and Circadian Function J Biol Rhythms, August 1, 2007; 22(4): 291 - 298. [Abstract] [PDF]
|
|
|
|
|
|
J. Holt-Lunstad and P. R. Steffen Diurnal Cortisol Variation is Associated With Nocturnal Blood Pressure Dipping Psychosom Med, May 1, 2007; 69(4): 339 - 343. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Ryan, J. K. Carroll, E. P. Ryan, K. M. Mustian, K. Fiscella, and G. R. Morrow Mechanisms of Cancer-Related Fatigue Oncologist, May 1, 2007; 12(suppl_1): 22 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Wrosch, G. E. Miller, M. F. Scheier, and S. B. de Pontet Giving Up on Unattainable Goals: Benefits for Health? Pers Soc Psychol Bull, February 1, 2007; 33(2): 251 - 265. [Abstract] [PDF]
|
|
|
|
 |
|
 I. Iurisci, E. Filipski, J. Reinhardt, S. Bach, A. Gianella-Borradori, S. Iacobelli, L. Meijer, and F. Levi Improved Tumor Control through Circadian Clock Induction by Seliciclib, a Cyclin-Dependent Kinase Inhibitor. Cancer Res., November 15, 2006; 66(22): 10720 - 10728. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Power, L. Li, and C. Hertzman Associations of Early Growth and Adult Adiposity with Patterns of Salivary Cortisol in Adulthood J. Clin. Endocrinol. Metab., November 1, 2006; 91(11): 4264 - 4270. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Blackwell, C. F. M. de Leon, and G. E. Miller Applying Mixed Regression Models to the Analysis of Repeated-Measures Data in Psychosomatic Medicine Psychosom Med, November 1, 2006; 68(6): 870 - 878. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Gholam, S. Giacchetti, C. Brezault-Bonnet, M. Bouchahda, D. Hauteville, R. Adam, B. Ducot, O. Ghemard, F. Kustlinger, C. Jasmin, et al. Chronomodulated Irinotecan, Oxaliplatin, and Leucovorin-Modulated 5-Fluorouracil as Ambulatory Salvage Therapy in Patients with Irinotecan- and Oxaliplatin-Resistant Metastatic Colorectal Cancer Oncologist, November 1, 2006; 11(10): 1072 - 1080. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Guo, D. L. Musselman, A. K. Manatunga, N. Gilles, K. C. Lawson, M. R. Porter, J. S. McDaniel, and C. B. Nemeroff The Diagnosis of Major Depression in Patients With Cancer: A Comparative Approach Psychosomatics, October 1, 2006; 47(5): 376 - 384. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. A. Saxe, J. M. Major, J. Y. Nguyen, K. M. Freeman, T. M. Downs, and C. E. Salem Potential attenuation of disease progression in recurrent prostate cancer with plant-based diet and stress reduction. Integr Cancer Ther, September 1, 2006; 5(3): 206 - 213. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Gore-Felton, C. Koopman, D. Spiegel, M. Vosvick, M. Brondino, and A. Winningham Effects of Quality of Life and Coping on Depression among Adults Living with HIV/AIDS. J Health Psychol, September 1, 2006; 11(5): 711 - 729. [Abstract] [PDF]
|
|
|
|
|
|
J. Giese-Davis, F. H. Wilhelm, A. Conrad, H. C. Abercrombie, S. Sephton, M. Yutsis, E. Neri, C. B. Taylor, H. C. Kraemer, and D. Spiegel Depression and stress reactivity in metastatic breast cancer. Psychosom Med, September 1, 2006; 68(5): 675 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. L. Urry, C. M. van Reekum, T. Johnstone, N. H. Kalin, M. E. Thurow, H. S. Schaefer, C. A. Jackson, C. J. Frye, L. L. Greischar, A. L. Alexander, et al. Amygdala and ventromedial prefrontal cortex are inversely coupled during regulation of negative affect and predict the diurnal pattern of cortisol secretion among older adults. J. Neurosci., April 19, 2006; 26(16): 4415 - 4425. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. C. Kraemer, J. Giese-Davis, M. Yutsis, R. O'Hara, E. Neri, D. Gallagher-Thompson, C. B. Taylor, and D. Spiegel Design Decisions to Optimize Reliability of Daytime Cortisol Slopes in an Older Population Am J Geriatr Psychiatry, April 1, 2006; 14(4): 325 - 333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Gallagher-Thompson, G. R. Shurgot, K. Rider, H. L. Gray, C. L. McKibbin, H. C. Kraemer, S. E. Sephton, and L. W. Thompson Ethnicity, Stress, and Cortisol Function in Hispanic and Non-Hispanic White Women: A Preliminary Study of Family Dementia Caregivers and Noncaregivers Am J Geriatr Psychiatry, April 1, 2006; 14(4): 334 - 342. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. F. Robles, V. A. Shaffer, W. B. Malarkey, and J. K. Kiecolt-Glaser Positive behaviors during marital conflict: Influences on stress hormones Journal of Social and Personal Relationships, April 1, 2006; 23(2): 305 - 325. [Abstract] [PDF]
|
|
|
|
 |
|
 A. N. Saul, T. M. Oberyszyn, C. Daugherty, D. Kusewitt, S. Jones, S. Jewell, W. B. Malarkey, A. Lehman, S. Lemeshow, and F. S. Dhabhar Chronic Stress and Susceptibility to Skin Cancer J Natl Cancer Inst, December 7, 2005; 97(23): 1760 - 1767. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. E. Blask, G. C. Brainard, R. T. Dauchy, J. P. Hanifin, L. K. Davidson, J. A. Krause, L. A. Sauer, M. A. Rivera-Bermudez, M. L. Dubocovich, S. A. Jasser, et al. Melatonin-Depleted Blood from Premenopausal Women Exposed to Light at Night Stimulates Growth of Human Breast Cancer Xenografts in Nude Rats Cancer Res., December 1, 2005; 65(23): 11174 - 11184. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Arjona and D. K. Sarkar Circadian Oscillations of Clock Genes, Cytolytic Factors, and Cytokines in Rat NK Cells J. Immunol., June 15, 2005; 174(12): 7618 - 7624. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Fairey, K. S. Courneya, C. J. Field, G. J. Bell, L. W. Jones, and J. R. Mackey Randomized controlled trial of exercise and blood immune function in postmenopausal breast cancer survivors J Appl Physiol, April 1, 2005; 98(4): 1534 - 1540. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Woods Intimate Partner Violence and Post-Traumatic Stress Disorder Symptoms in Women: What We Know and Need to Know J Interpers Violence, April 1, 2005; 20(4): 394 - 402. [Abstract] [PDF]
|
|
|
|
|
|
J. E. Bower, P. A. Ganz, and N. Aziz Altered Cortisol Response to Psychologic Stress in Breast Cancer Survivors With Persistent Fatigue Psychosom Med, March 1, 2005; 67(2): 277 - 280. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Rich, P. F. Innominato, J. Boerner, M. C. Mormont, S. Iacobelli, B. Baron, C. Jasmin, and F. Levi Elevated Serum Cytokines Correlated with Altered Behavior, Serum Cortisol Rhythm, and Dampened 24-Hour Rest-Activity Patterns in Patients with Metastatic Colorectal Cancer Clin. Cancer Res., March 1, 2005; 11(5): 1757 - 1764. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Haber, C. F. Toombs, E. Hamera, D. Hillyer, B. J. Limandri, S. Pagel, R. R. Staten, and M. L. Zimmerman Advanced Practice Psychiatric Nurses: 2004 Legislative Update Journal of the American Psychiatric Nurses Association, December 1, 2004; 10(6): 298 - 310. [PDF]
|
|
|
|
|
|
E. Filipski, F. Delaunay, V. M. King, M.-W. Wu, B. Claustrat, A. Grechez-Cassiau, C. Guettier, M. H. Hastings, and L. Francis Effects of Chronic Jet Lag on Tumor Progression in Mice Cancer Res., November 1, 2004; 64(21): 7879 - 7885. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Filipski, V. M. King, M.-C. Etienne, X. Li, B. Claustrat, T. G. Granda, G. Milano, M. H. Hastings, and F. Levi Persistent twenty-four hour changes in liver and bone marrow despite suprachiasmatic nuclei ablation in mice Am J Physiol Regulatory Integrative Comp Physiol, October 1, 2004; 287(4): R844 - R851. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Chow, M. N Tsao, and T. Harth Does psychosocial intervention improve survival in cancer? A meta-analysis Palliative Medicine, January 1, 2004; 18(1): 25 - 31. [Abstract] [PDF]
|
|
|
|
|
|
D. B. Boyd Insulin and Cancer Integr Cancer Ther, December 1, 2003; 2(4): 315 - 329. [Abstract] [PDF]
|
|
|
|
|
|
G. A. Saxe Integrative Tumor Board: Recently Diagnosed Prostate Cancer Integr Cancer Ther, March 1, 2003; 2(1): 65 - 73. [PDF]
|
|
|
|
|
|
B. M. Kudielka, J. E. Broderick, and C. Kirschbaum Compliance With Saliva Sampling Protocols: Electronic Monitoring Reveals Invalid Cortisol Daytime Profiles in Noncompliant Subjects Psychosom Med, March 1, 2003; 65(2): 313 - 319. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Edwards, F. Hucklebridge, A. Clow, and P. Evans Components of the Diurnal Cortisol Cycle in Relation to Upper Respiratory Symptoms and Perceived Stress Psychosom Med, March 1, 2003; 65(2): 320 - 327. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Faller and H. Bulzebruck Coping and Survival in Lung Cancer: A 10-Year Follow-Up Am J Psychiatry, December 1, 2002; 159(12): 2105 - 2107. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. S. Dhabhar A Hassle a Day May Keep the Doctor Away: Stress and the Augmentation of Immune Function Integr. Comp. Biol., July 1, 2002; 42(3): 556 - 564. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. Bower, P. A. Ganz, N. Aziz, and J. L. Fahey Fatigue and Proinflammatory Cytokine Activity in Breast Cancer Survivors Psychosom Med, July 1, 2002; 64(4): 604 - 611. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Filipski, V. M. King, X. Li, T. G. Granda, M.-C. Mormont, X. Liu, B. Claustrat, M. H. Hastings, and F. Levi Host Circadian Clock as a Control Point in Tumor Progression J Natl Cancer Inst, May 1, 2002; 94(9): 690 - 697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Spiegel and S. Sephton Re: Night Shift Work, Light at Night, and Risk of Breast Cancer J Natl Cancer Inst, April 3, 2002; 94(7): 530 - 530. [Full Text] [PDF]
|
|
|
|
 |
|
 D. Spiegel Mind Matters -- Group Therapy and Survival in Breast Cancer N. Engl. J. Med., December 13, 2001; 345(24): 1767 - 1768. [Full Text] [PDF]
|
|
|
|
|
|
L. Cohen, C. de Moor, D. Devine, A. Baum, and R. J. Amato Endocrine Levels at the Start of Treatment Are Associated With Subsequent Psychological Adjustment in Cancer Patients With Metastatic Disease Psychosom Med, November 1, 2001; 63(6): 951 - 958. [Abstract] [Full Text] [PDF]
|
|