Samayoa Cathy, Santana-Ufret Veronica, Santoyo-Olsson Jasmine, Strassle Paula D, Stewart Anita, Bonilla Jackie, Escalera Cristian, Mendez Rebecca Margarita, Márquez-Magaña Leticia, Ortiz Carmen, Ceballos Rachel M, Nápoles Anna Maria
Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., San Francisco, CA, 94143, USA.
Health & Equity Research Lab, Department of Biology, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA.
Compr Psychoneuroendocrinol. 2022 Jun 24;11:100153. doi: 10.1016/j.cpnec.2022.100153. eCollection 2022 Aug.
Compared to their White counterparts, Latina breast cancer survivors have poorer survival rates and health-related quality of life, and higher rates of depression and anxiety which may be a result of chronic stress. Chronic stress impacts the hypothalamic-pituitary-adrenal (HPA) axis, resulting in cortisol dysregulation which may be associated with breast cancer survival. However, cortisol levels and cortisol profiles of Latina breast cancer survivors are poorly characterized due to their underrepresentation in biomedical research.
The objective of this study was to describe cortisol levels and patterns of cortisol secretions in rural Latina breast cancer survivors participating in an RCT study of , an evidence-based peer-delivered cognitive behavioral stress management intervention.
Participant-centered recruitment and collection strategies were used to obtain biospecimens for cortisol analysis. Nine saliva samples (3/day for 3 days) and a hair sample were obtained at baseline and 6-months (3-months post-intervention). We describe cortisol levels and profiles, explore correlations of biomarkers with self-report measures of stress and psychological distress, and compare women who received the intervention with a delayed intervention group on biomarkers of stress. Mean hair cortisol concentration (HCC) was used to assess chronic stress. Based on daily measures of cortisol (awakening, 30 min post-awakening, and bedtime), we calculated three summary measures of the dynamic nature of the cortisol awakening response (CAR): 1) the CAR slope, 2) whether CAR demonstrates a percent change ≥40, and 3) total daily cortisol output (AUCg). Linear and log-binomial regression, accounting for multiple samples per participant, were used to compare cortisol measures at 6-month follow-up by treatment arm.
Participants (n = 103) were from two rural California communities; 76 provided at least one saliva sample at baseline and follow-up and were included in the analysis. At baseline, mean age was 57 years, mean years since diagnosis was 2 years, 76% had a high school education or less, and 34% reported financial hardship. The overall median CAR slope was 0.10, and median cortisol AUCg (in thousands) was 11.34 (range = 0.93, 36.66). Mean hair cortisol concentration was 1751.6 pg/mg (SD = 1148.6). Forty-two percent of samples had a ≥40% change in CAR. We found no statistically significant correlations between the cortisol measures and self-reported measures of stress and psychological distress. At follow-up, no differences were seen in HCC (mean difference between intervention and control: -0.11, 95% CI -0.48, 0.25), CAR slope (0.001, 95% CI -0.005, 0.008), cortisol AUCg (-0.15, 95% CI -0.42, 0.13), or ≥40% change in CAR (prevalence ratio 0.87, 95% CI 0.42, 1.77) between treatment arms.
Our findings of flattened cortisol profiles among more than half of the sample suggest potential HPA-axis dysregulation among rural Spanish-speaking Latina breast cancer survivors that merits further study due to its implications for long-term survival.
http://www.ClinicalTrials.gov identifier NCT02931552.
与白人乳腺癌幸存者相比，拉丁裔乳腺癌幸存者的生存率和与健康相关的生活质量较差，抑郁和焦虑发生率较高，这可能是慢性应激的结果。慢性应激会影响下丘脑 - 垂体 - 肾上腺（HPA）轴，导致皮质醇失调，这可能与乳腺癌的生存有关。然而，由于拉丁裔乳腺癌幸存者在生物医学研究中的代表性不足，其皮质醇水平和皮质醇谱的特征尚不明确。
本研究的目的是描述参与一项基于证据的同伴提供的认知行为压力管理干预随机对照试验的农村拉丁裔乳腺癌幸存者的皮质醇水平和皮质醇分泌模式。
采用以参与者为中心的招募和收集策略获取用于皮质醇分析的生物标本。在基线和6个月（干预后3个月）时获取9份唾液样本（连续3天每天3份）和1份头发样本。我们描述皮质醇水平和谱，探索生物标志物与压力和心理困扰的自我报告测量之间的相关性，并比较接受干预的女性与延迟干预组在压力生物标志物方面的差异。平均头发皮质醇浓度（HCC）用于评估慢性应激。基于皮质醇的日常测量（觉醒时、觉醒后30分钟和就寝时），我们计算了皮质醇觉醒反应（CAR）动态性质的三个汇总测量值：1）CAR斜率，2）CAR是否显示百分比变化≥40%，以及3）每日皮质醇总输出量（AUCg）。使用考虑每个参与者多个样本的线性和对数二项回归来比较治疗组在6个月随访时的皮质醇测量值。
参与者（n = 103）来自加利福尼亚州的两个农村社区；76人在基线和随访时提供了至少一份唾液样本并纳入分析。基线时，平均年龄为57岁，自诊断以来的平均年数为2年，76%的人具有高中及以下学历，34%的人报告有经济困难。总体CAR斜率中位数为0.10，皮质醇AUCg中位数（以千为单位）为11.34（范围 = 0.93，36.66）。平均头发皮质醇浓度为1751.6 pg/mg（SD = 1148.6）。42%的样本CAR变化≥40%。我们发现皮质醇测量值与压力和心理困扰的自我报告测量之间无统计学显著相关性。在随访时，治疗组之间在HCC（干预组与对照组的平均差异：-0.11，95%CI -0.48，0.25）、CAR斜率（0.001，95%CI -0.005，0.008）、皮质醇AUCg（-0.15，95%CI -0.42，0.13）或CAR≥40%变化（患病率比0.87，95%CI 0.42，1.77）方面未见差异。
我们在超过一半的样本中发现皮质醇谱变平这一结果表明，农村说西班牙语的拉丁裔乳腺癌幸存者中可能存在HPA轴失调，鉴于其对长期生存的影响，值得进一步研究。
