Cortisol and inflammatory processes in ovarian cancer patients following primary treatment: Relationships with depression, fatigue, and disability

Abstract

Elevations in the pro-inflammatory cytokine interleukin-6 (IL-6) and alterations in the anti-inflammatory hormone cortisol have been reported in a variety of cancers. IL-6 has prognostic significance in ovarian cancer and cortisol has been associated with fatigue, disability, and vegetative depression in ovarian cancer patients prior to surgery. Ovarian cancer patients undergoing primary treatment completed psychological self-report measures and collected salivary cortisol and plasma IL-6 prior to surgery, at six months, and at one year. Patients included in this study had completed chemotherapy and had no evidence of disease recurrence. At six months, patients showed significant reductions in nocturnal cortisol secretion, plasma IL-6, and a more normalized diurnal cortisol rhythm, changes that were maintained at one year. The reductions in IL-6 and nocturnal cortisol were associated with declines in self-reported fatigue, vegetative depression, and disability. These findings suggest that primary treatment for ovarian cancer reduces the inflammatory response. Moreover, patients who have not developed recurrent disease by one year appear to maintain more normalized levels of cortisol and IL-6. Improvement in fatigue and vegetative depression is associated with the normalization of IL-6 and cortisol, a pattern which may be relevant for improvements in overall quality of life for ovarian cancer patients.

Cancer-related fatigue shows a stable association with diurnal cortisol dysregulation in breast cancer patients

“…In contrast to our and Bower's study, fatigue was significantly associated with higher morning cortisol and a lower CAR. In addition, among ovarian cancer patients before surgery fatigue was also associated with elevated evening cortisol and blunted diurnal cortisol slopes, and the normalization of the cortisol dysregulation within the months following surgery was associated with declines in fatigue [31,32]. Taken these previous and our studies together, fatigue appears to be related to increased evening cortisol levels throughout different timepoints during the cancer continuum.…”

Day-to-Day Dynamics of Associations Between Sleep, Napping, Fatigue, and the Cortisol Diurnal Rhythm in Women Diagnosed as Having Breast Cancer

“…Second, we were unable to partial out the contribution of cancer-related biological factors to the dysregulation of the cortisol rhythm. Others demonstrate in ovarian cancer patients that tumor reduction/elimination through chemotherapy associates with normalization of the cortisol rhythm and tumor-derived inflammation (57). Women in our sample, however, had early stage cancer and were evaluated after surgical removal of their cancer; thus, reducing the possibility that tumor-related inflammation contributed to the observed disruption of the cortisol diurnal rhythm.…”

Depression in cancer: The many biobehavioral pathways driving tumor progression

“…For instance, surgical treatment followed by chemotherapy in high-risk ovarian cancer patients was found to be effective in reducing IL-6 levels and nocturnal cortisol and in improving neurovegetative symptoms of depression, fatigue and quality of life 69 . However, other lines of evidence indicate that cancer treatments may induce per se inflammatory pathways relevant to the development of depressive symptoms.…”