Department of Psychology, University of Iowa, Iowa City, Iowa 52242, USA.
Cancer. 2010 Sep 15;116(18):4410-9. doi: 10.1002/cncr.25299.
Multiple alterations in circadian rhythms have been observed in cancer patients, including the diurnal rhythm of the adrenal hormone cortisol. Diurnal cortisol alterations have been associated with cancer-related physiological processes as well as psychological stress. Here we investigate alterations in diurnal cortisol rhythm in ovarian cancer patients, and potential links with depression, life stress, and functional disability.
Women (n = 177) with suspected ovarian cancer completed questionnaires and collected salivary cortisol 3× daily for 3 consecutive days before surgery. One hundred women were subsequently diagnosed with ovarian cancer and 77 with benign disease. In addition, healthy women (n = 33) not scheduled for surgery collected salivary cortisol at the same time points.
Ovarian cancer patients demonstrated significantly elevated nocturnal cortisol (P = .022) and diminished cortisol variability (P = .023) compared with women with benign disease and with healthy women (all P values <.0001). Among ovarian cancer patients, higher levels of nocturnal cortisol and less cortisol variability were significantly associated with greater functional disability, fatigue, and vegetative depression, but not with stress, distress, or depressed affect. There were no significant associations between functional or psychological variables and diurnal cortisol in women with benign disease.
Nocturnal cortisol and cortisol variability show significant dysregulation in ovarian cancer patients, and this dysregulation was associated with greater functional disability, fatigue, and vegetative depression. These findings suggest potential hypothalamic-pituitary-adrenal involvement in functional disability in ovarian cancer, and may have implications for disease progression.
癌症患者的昼夜节律发生了多种改变，包括肾上腺激素皮质醇的昼夜节律。昼夜皮质醇变化与癌症相关的生理过程以及心理压力有关。在这里，我们研究了卵巢癌患者昼夜皮质醇节律的改变，以及与抑郁、生活压力和功能障碍的潜在联系。
疑似卵巢癌的女性（n = 177）完成了问卷调查，并在手术前连续 3 天每天采集 3 次唾液皮质醇。随后，100 名女性被诊断为卵巢癌，77 名女性被诊断为良性疾病。此外，不计划手术的健康女性（n = 33）在相同时间点采集唾液皮质醇。
与良性疾病患者和健康女性相比，卵巢癌患者的夜间皮质醇水平显著升高（P =.022），皮质醇变异性降低（P =.023）（所有 P 值均<.0001）。在卵巢癌患者中，较高的夜间皮质醇水平和较低的皮质醇变异性与更大的功能障碍、疲劳和植物性抑郁显著相关，但与压力、痛苦或抑郁情绪无关。在良性疾病患者中，功能或心理变量与日间皮质醇之间没有显著关联。
卵巢癌患者的夜间皮质醇和皮质醇变异性存在明显失调，这种失调与更大的功能障碍、疲劳和植物性抑郁有关。这些发现表明，下丘脑-垂体-肾上腺功能障碍可能与卵巢癌患者的功能障碍有关，并且可能对疾病进展有影响。
