Nighttime salivary cortisol as a biomarker of stress and an indicator of worsening quality of life in patients with head and neck cancer: A cross-sectional study

Background

Head and neck cancer (HNC) is a generic term defined on an anatomical-topographic basis to describe malignant tumors located in the oral cavity, pharynx, larynx, and thyroid. A situation commonly presented by individuals with cancer is stress, with evidence indicating a close relationship between stress, behavior, and the immune system with the development and progression of cancer.

Aim

To assess the association between stress levels and quality of life among individuals with HNC.

Methods

This was a cross-sectional study involving 72 HNC patients. The University of Washington Quality of Life Questionnaire was used to assess the quality of life, while the Perceived Stress Scale and salivary cortisol were used to evaluate stress levels.

Results

A negative association was found between quality of life and stress levels as indicated by both the PSS and nighttime salivary cortisol. Nighttime salivary cortisol showed the best accuracy estimated by the area under the receiver operating characteristic curve, slightly better than that of PSS.

Conclusion

Among the time points for saliva sampling, nighttime cortisol was found to have the best accuracy, which was similar to that of the PSS, for the detection of patients with the worst quality of life.

Multi-Dimensional Scaling Analysis of Key Regulatory Genes in Prostate Cancer Using the TCGA Database

Prostate cancer (PC) is a polygenic disease with multiple gene interactions. Therefore, a detailed analysis of its epidemiology and evaluation of risk factors can help to identify more accurate predictors of aggressive disease. We used the transcriptome data from a cohort of 243 patients from the Cancer Genome Atlas (TCGA) database. Key regulatory genes involved in proliferation activity, in the regulation of stress, and in the regulation of inflammation processes of the tumor microenvironment were selected to test a priori multi-dimensional scaling (MDS) models and create a combined score to better predict the patients' survival and disease-free intervals. Survival was positively correlated with cortisol expression and negatively with Mini-Chromosome Maintenance 7 (MCM7) and Breast-Related Cancer Antigen2 (BRCA2) expression. The disease-free interval was negatively related to the expression of enhancer of zeste homolog 2 (EZH2), MCM7, BRCA2, and programmed cell death 1 ligand 1 (PD-L1). MDS suggested two separate pathways of activation in PC. Within these two dimensions three separate clusters emerged: (1) cortisol and brain-derived neurotrophic factor BDNF, (2) PD-L1 and cytotoxic-T-lymphocyte-associated protein 4 (CTL4); (3) and finally EZH2, MCM7, BRCA2, and c-Myc. We entered the three clusters of association shown in the MDS in several Kaplan-Meier analyses. It was found that only Cluster 3 was significantly related to the interval-disease free, indicating that patients with an overall higher activity of regulatory genes of proliferation and DNA repair had a lower probability to have a longer disease-free time. In conclusion, our data study provided initial evidence that selecting patients with a high grade of proliferation and DNA repair activity could lead to an early identification of an aggressive PC with a potentials for metastatic development.

The Sum of Fears in Cancer Patients Inside the Context of the COVID-19

The pandemic resulting from COVID-19 has led to the collapse of the health system in dozens of countries. Parallel to clinical risk, the appearance or intensification of psychiatric symptoms has also been documented. The identification of groups at risk is essential for the establishment of preventive and therapeutic strategies. Cancer patients appear to be especially vulnerable both from a clinical and psychiatric perspective. Problems related to contamination and the cancer treatments themselves are intertwined, causing a sum of patients' fears to arise, which can cause mental effects. This study aims to review and investigate the impact of COVID-19 on the mental health of cancer patients and indicate possible support strategies.

Chronic stress decreases ornithine decarboxylase expression and protects against 1,2-dimethylhydrazine-induced colon carcinogenesis

Biological response to stress depends on the type, timing, and severity of the stressor. Acute stressful environments may positively activate molecular and cellular mechanisms to favor adaptation; however, chronic stress is often associated with detrimental health effects. Colon cancer (CC) is one of the leading causes of death associated with cancer and has been mentioned as a stress-related disease. In the present work, the effect of chronic stress on the initial phase of CC was evaluated, and special emphasis was placed on ornithine decarboxylase (ODC) expression and polyamines for their role in hyperproliferative diseases. BALB/c mice (n = 5/group) were administered the pro-carcinogen 1,2-dimethylhydrazine (DMH) for 8 weeks (20 mg/kg body weight/week) to induce colon carcinogenesis, and then exposed for 4 weeks to two physical stressors: restraint and forced-swimming. Distal colon inflammatory lesions and histomorphological changes were evaluated by hematoxylin-eosin staining; plasma corticosterone levels, colon ODC expression, and urinary polyamines were determined by competitive ELISA, RT-qPCR, Western Blot, and HPLC, respectively. The short-term exposure to DMH triggered colon inflammation, initiated colon carcinogenesis and increased ODC expression; meanwhile, the exposure to chronic stress activated the hypothalamic-pituitary-adrenal (HPA) axis, elicited the production of plasmatic corticosterone, and decreased ODC expression. The exposure of DMH-treated mice to chronic stress counteracted the inflammatory effect of DMH and maintained ODC homeostasis. In early phase of carcinogenesis, the exposure of DMH-treated mice to chronic stress had a positive effect against colon inflammation and maintained ODC homeostasis. The cross-talk between corticosterone, ODC expression, and inflammation in a tumor environment is discussed.

Stress alters the expression of cancer-related genes in the prostate

Background

Prostate cancer is a major contributor to mortality worldwide, and significant efforts are being undertaken to decipher specific cellular and molecular pathways underlying the disease. Chronic stress is known to suppress reproductive function and promote tumor progression in several cancer models, but our understanding of the mechanisms through which stress contributes to cancer development and progression is incomplete. We therefore examined the relationship between stress, modulation of the gonadotropin-releasing hormone (GnRH) system, and changes in the expression of cancer-related genes in the rat prostate.

Methods

Adult male rats were acutely or repeatedly exposed to restraint stress, and compared to unstressed controls and groups that were allowed 14 days of recovery from the stress. Prostate tissue was collected and frozen for gene expression analyses by PCR array before the rats were transcardially perfused; and brain tissues harvested and immunohistochemically stained for Fos to determine neuronal activation.

Results

Acute stress elevated Fos expression in the paraventricular nucleus of the hypothalamus (PVH), an effect that habituated with repeated stress exposure. Data from the PCR arrays showed that repeated stress significantly increases the transcript levels of several genes associated with cellular proliferation, including proto-oncogenes. Data from another array platform showed that both acute and repeated stress can induce significant changes in metastatic gene expression. The functional diversity of genes with altered expression, which includes transcription factors, growth factor receptors, apoptotic genes, and extracellular matrix components, suggests that stress is able to induce aberrant changes in pathways that are deregulated in prostate cancer.

Conclusions

Our findings further support the notion that stress can affect cancer outcomes, perhaps by interfering with neuroendocrine mechanisms involved in the control of reproduction.

Electronic supplementary material

The online version of this article (10.1186/s12885-017-3635-4) contains supplementary material, which is available to authorized users.

The childhood maltreatment influences on breast cancer patients: A second wave hit model hypothesis for distinct biological and behavioral response

Stress and cancer are two complex situations involving different biological and psychological mechanisms. Their relationship have long been studied, and there is evidence of the impact stress has on both, development and disease progression. Furthermore, early stress has been studied as an important factor associated to this relationship, since its impacts on the immune, endocrine and cognitive development throughout life is already known. Therefore, understanding early stress as a first wave of stress in life is necessary in order to explore a possible second wave hit model. From this perspective, we believe that breast cancer can be understood as a second wave of stress during development and that, in addition to the first wave, can cause important impacts on the response to cancer treatment, such as increased chances of disease progression and distinct behavioral responses. In this article we propose a second wave hit hypothesis applied to breast cancer and its implications on the immune, endocrine and cognitive systems, through mechanisms that involve the HPA axis and subsequent activations of stress responses.

Cancer risk among Holocaust survivors in Israel-A nationwide study

BACKGROUND

Holocaust survivors during World War II were exposed to various factors that are associated with cancer risk. The objective of this study was to determine whether Holocaust survivors had an increased risk for developing cancer.

METHODS

The study population included 152,622 survivors. The main analysis was based on a comparison between individuals who were entitled to compensation for suffering persecution during the war and individuals who were denied such compensation. A complementary analysis compared survivors who were born in countries governed by Nazi Germany with survivors born in nonoccupied countries. A Cox proportional hazards model was used, with the time at risk of cancer development starting on either January 1, 1960, or the date of immigration to the date of cancer diagnosis or death or the date of last follow-up (December 31, 2006).

RESULTS

Cancer was diagnosed in 22.2% of those who were granted compensation versus 16% of those who were denied compensation (P < .0001). Adjusting for birth cohort, sex, country of origin, and period of immigration, both analyses revealed significant increased risks of developing cancer in those who were exposed. For those who were granted versus denied compensation, the hazard ratios were 1.06 (P < .001) for all sites, 1.12 (P = .07) for colorectal cancer, and 1.37 (P = .008) for lung cancer. For those born in occupied countries versus nonoccupied countries, the hazard ratios were 1.08 (P < .001), 1.08 (P = .003), and 1.12 (P = .02), respectively.

CONCLUSIONS

The current results, based on a large cohort of Holocaust survivors who were exposed to a variety of severe deprivations, add to the conflicting and sparse knowledge on this issue and support the notion that this group has a small but consistent increase in cancer development. Cancer 2017;123:3335-45. © 2017 American Cancer Society.

Intimate partner violence and women's cancer quality of life

PURPOSE

Because intimate partner violence (IPV) may disproportionately impact women's quality of life (QOL) when undergoing cancer treatment, women experiencing IPV were hypothesized to have (a) more symptoms of depression or stress and (b) lower QOL as measured with the Functional Assessment of Cancer Therapy (FACT-B) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) Scales relative to those never experiencing IPV.

METHODS

Women, aged 18-79, who were included in one of two state cancer registries from 2009 to 2015 with a recent incident, primary, invasive biopsy-confirmed cancer diagnosis were recruited and asked to complete a phone interview, within 12 months of diagnosis. This interview measured IPV by timing (current and past) and type (physical, sexual, psychological), socio-demographics, and health status. Cancer registries provided consenting women's cancer stage, site, date of diagnosis, and age.

RESULTS

In this large cohort of 3,278 women who completed a phone interview, 1,221 (37.3%) disclosed lifetime IPV (10.6% sexual, 24.5% physical, and 33.6% psychological IPV). Experiencing IPV (particularly current IPV) was associated with poorer cancer-related QOL defined as having more symptoms of depression and stress after cancer diagnosis and lower FACIT-SP and FACT scores than women not experiencing IPV and controlling for confounders including demographic factors, cancer stage, site, and number of comorbid conditions. Current IPV was more strongly associated with poorer QOL. When compared with those experiencing past IPV (and no IPV), women with cancer who experienced current IPV had significantly higher depression and stress symptoms scores and lower FACIT-SP and FACT-G scores indicating poorer QOL for all domains. While IPV was not associated with being diagnosed at a later cancer stage, current IPV was significantly associated with having more than one comorbid physical conditions at interview (adjusted rate ratio = 1.35; 95% confidence interval 1.19-1.54) and particularly for women diagnosed with cancer when <55 years of age.

CONCLUSIONS

Current and past IPV were associated with poorer mental and physical health functioning among women recently diagnosed with cancer. Including clinical IPV screening may improve women's cancer-related QOL.

Partner interfering behaviors affecting cancer quality of life

Objective

Because partners are an important and unpaid resource in cancer care, understanding how destructive, controlling or interfering partner behaviors influence women's cancer care may be particularly relevant for health care providers seeking to provide cancer care and enhance recovery. Using a new measure of partner interfering behaviors in cancer care (PIB‐C), we investigated whether women with a recent cancer diagnosis who additionally endorsed any PIB‐C would report (a) more symptoms of depression and stress, and (b) lower Functional Assessment of Cancer Therapy (FACT‐G) and lower Functional Assessment of Chronic Illness Therapy‐Spiritual Well‐being (FACIT‐SP) scale scores indicating poorer quality of life (QOL).

Methods

Women aged 18–79 included in cancer registries as having an incident, primary, biopsy‐confirmed cancer in the past 12 months were eligible for this study. Consenting women completed a phone interview 9–12 months following cancer diagnosis between 2009 and 2015. Interviews provided data to measure outcomes (perceived stress and depressive symptoms, FACIT‐SP and FACT‐G scores), partner supportive and interfering behaviors, and other potentially confounding factors.

Results

Of the 2376 women in a relationship at cancer diagnosis, 14.7% endorsed one or more of 14 PIB‐C items. Women endorsing any PIB‐C item reported more symptoms of depression and stress and lower FACT‐G and FACIT‐SP scores than partnered women reporting no PIB‐C even when controlling for partner supportive behaviors and lifetime intimate partner violence. Increasing PIB‐C scores were also correlated, in a dose–response pattern, with these same outcomes.

Conclusions

Partner interfering behaviors during cancer care impact patients' QOL across multiple domains. © 2016 The Authors. Psycho‐Oncology Published by John Wiley & Sons Ltd.