Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa.
Department of Psychiatry, University of Iowa, Iowa City, Iowa.
Cancer. 2018 Aug;124(16):3401-3408. doi: 10.1002/cncr.31570. Epub 2018 Jun 15.
Patients with ovarian cancer often report elevated anxiety at diagnosis that decreases posttreatment. However, a minority of patients experience sustained anxiety. Few studies have examined risk factors for persistent anxiety or its physiologic sequelae in ovarian cancer. Therefore, the authors investigated associations between prior life events, anxiety, inflammation (plasma levels of interleukin-6), and diurnal cortisol profiles in patients with ovarian cancer during the first year postdiagnosis.
Participants (n = 337) completed surveys and had blood and salivary sampling prediagnosis, postchemotherapy (6 months), and 12 months after diagnosis. The Life Events and Difficulties Schedule was administered to a patient subset (n = 127) within 1 month of diagnosis. Linear mixed-effects models were used to analyze relations between anxiety and biologic variables over time. Linear regression models assessed whether anxiety trajectories mediated associations between prior stress exposure and biologic variables. Age, chemotherapy at 1 year, and cancer stage were covariates.
Decreased anxiety was associated with a more normalized cortisol slope over time (β = 0.092; P = .047). Early life adversity was related to flatter cortisol slopes over time (β = -0.763; P = .002); this relation was partially mediated by anxiety trajectory (P = .046). More danger-related events prediagnosis were associated with sustained anxiety (β = 0.537; P = .019) and flatter cortisol slopes over time (β = -0.243; P = .047); anxiety partially mediated the relation between danger and cortisol slope (P = .037). Neither anxiety nor prior stress exposure was related to levels of interleukin-6.
Because dysregulated cortisol has been related to fatigue, poorer quality of life, and shorter survival in patients with ovarian cancer, those who have prior life events and chronic anxiety during the first year postdiagnosis may be at risk for more negative outcomes. Cancer 2018. © 2018 American Cancer Society.
卵巢癌患者在诊断时常常报告焦虑水平升高，治疗后会降低。然而，少数患者会持续焦虑。很少有研究探讨卵巢癌患者持续性焦虑及其生理后果的危险因素。因此，作者在卵巢癌患者诊断后第一年调查了先前生活事件、焦虑、炎症（白细胞介素 6 血浆水平）和皮质醇昼夜节律与患者之间的关系。
参与者（n=337）在诊断前、化疗后（6 个月）和诊断后 12 个月完成了调查并进行了血液和唾液取样。在诊断后 1 个月内，对患者亚组（n=127）进行了生活事件和困难情况表的评估。线性混合效应模型用于分析随时间推移焦虑与生物学变量之间的关系。线性回归模型评估了焦虑轨迹是否在先前应激暴露与生物学变量之间的关系中起中介作用。年龄、1 年时的化疗和癌症分期为协变量。
焦虑程度降低与皮质醇斜率随时间更正常化相关（β=0.092；P=0.047）。早期逆境与随时间推移皮质醇斜率变平有关（β=-0.763；P=0.002）；这种关系部分通过焦虑轨迹介导（P=0.046）。诊断前更多的危险相关事件与持续焦虑（β=0.537；P=0.019）和随时间推移皮质醇斜率变平有关（β=-0.243；P=0.047）；焦虑部分中介了危险与皮质醇斜率之间的关系（P=0.037）。焦虑和先前的应激暴露都与白细胞介素-6 水平无关。
由于皮质醇失调与卵巢癌患者的疲劳、生活质量较差和生存率降低有关，因此在诊断后第一年经历先前生活事件和慢性焦虑的患者可能面临更负面的结果。癌症 2018. © 2018 美国癌症协会。
