Feasibility and value of salivary cortisol sampling to reflect distress in head and neck cancer patients undergoing chemoradiation: A proof-of-concept study

BACKGROUND

Head and neck cancer (HNC) patients undergoing chemo/radiation commonly experience severe and persistent distress associated with treatment related fear and physical side effects such as xerostomia, dysphagia, and dryness of mouth. Cortisol, a stress sensitive hormone, can be easily measured in saliva to reflect biobehavioral responses to such stressors. Unfortunately, it has not been used in this population due to concerns associated with chemoradiation (C/RT) related xerostomia.

METHODS

In a proof-of-concept study, we explored the feasibility of collecting salivary cortisol as a marker of fear and distress in HNC patients. Ten HNC subjects undergoing C/RT provided saliva samples for 3 consecutive days across three timepoints (pre-treatment, 3-weeks and 1-month post-treatment) and completed concurrent depression, anxiety and swallowing related fear measures.

RESULTS

Salivary cortisol collection adherence was between 80-60%. It was not impacted by xerostomia. Diurnal cortisol pattern demonstrated dysregulation at pretreatment in 62%, and flattened aberrant slopes continued at 3-weeks and beyond in 50% of subjects.

CONCLUSIONS

Our study supports the feasibility and utility of salivary cortisol measurement in HNC patients across the treatment trajectory. Diurnal cortisol measures may be a valuable tool to detect and monitor treatment distress during C/RT in this population.

Exposure to particulate matter, prenatal depressive symptoms and HPA axis dysregulation

BACKGROUND

The prevalence of depression during pregnancy is on the rise, affecting women's well-being and their children's health outcomes. Preliminary studies suggest that exposure to air pollution during pregnancy may play a role in development of depressive symptoms. In addition, pollution has been linked to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, our brain's primary stress response system. The purpose of this study was to examine the association of air pollution exposure during pregnancy to prenatal depressive symptoms. We also evaluated whether cortisol, the hormonal endpoint of HPA activation, mediated the relationship between exposure to pollution and prenatal depression.

METHODS

Women were recruited in obstetric clinics during their third trimester of pregnancy. They completed the Patient Health Questionnaire-9 to assess depression and provided salivary samples at 4 times during the day for 2 days. Four measures of cortisol were calculated from salivary assays: average cortisol level, cortisol awakening response (CAR), diurnal cortisol slope (DCS), and area under the curve (AUCG). We acquired data on particulate matter with a diameter of 2.5 μm (PM2.5) or less within each woman's residential area from public records of the air quality control district. Structural equation modeling was used to analyze the aims.

RESULTS

Increased prenatal exposure to PM2.5 across pregnancy was associated with more severe depressive symptoms during the 3rd trimester (β = 0.14, p = 0.02). Greater PM2.5 exposure also had significant relationships with both higher cortisol AUCG (β = 15.933, p = 0.005) and average cortisol levels (β = 0.018, p = 0.023) among women. However, no cortisol parameter appeared to mediate the relationship between PM2.5 exposure and depressive symptoms.

CONCLUSIONS

Findings suggest pregnancy may be a critical window of sensitivity to PM2.5 exposure that escalates depression risk and induces activation of the HPA axis, evidenced in greater overall cortisol concentration. Further research is needed to identify mechanisms underlying the effects of particulate matter, especially potential methylation of glucocorticoid or serotonin transporter genes that may elicit changes in both depression and the stress response system. In addition, assessment of depression appears warranted for pregnant women in regions known for high pollution.

Poor inhibition of personally-relevant facial expressions of sadness and anger predicts an elevated cortisol response following awakening six months later

Failure to inhibit interference from distracting emotional stimuli may obstruct an individual's ability to regulate their behavioural and emotional responses to environmental stressors. Few studies have examined the longitudinal association between cognitive inhibition and regulation of the hypothalamic-pituitary-adrenal axis (HPA) in the natural environment. Seventy-nine healthy adults underwent two assessments 6 months apart. Participants' ability to suppress interference from distracting emotional stimuli was assessed using a negative affective priming task that included both generic and personally-relevant (i.e., participants' intimate partners) facial expressions of emotion. Poorer inhibition of personally-relevant sad and angry faces, but not generic stimuli, significantly predicted an increased cortisol awakening response (CAR) six months later. Moreover, poor inhibition of personally-relevant sad faces mediated the relation between chronic stress and an elevated CAR. Difficulties inhibiting personally-relevant emotional information may represent a key mechanism in understanding how environmental stress influences HPA functioning.

Evidence of lasting dysregulation of neuroendocrine and HPA axis function following global cerebral ischemia in male rats and the effect of Antalarmin on plasma corticosterone level

Abnormal function of the neuroendocrine stress system has been implicated in the behavioral impairments observed following brain ischemia. The current study examined long-term changes in stress signal regulation 30days following global cerebral ischemia. Experiment 1 investigated changes in the expression of corticotropin releasing hormone (CRH) and its subtype 1 receptor (CRHR1), glucocorticoid receptors (GR) in the paraventricular nucleus of the hypothalamus (PVN), the central nucleus of the amygdala (CeA), and the CA1 subfield of the hippocampus. Tyrosine hydroxylase (TH) was determined at the locus coeruleus (LC). Experiment 2 investigated the role of central CRHR1 activation on corticosterone (CORT) secretion at multiple time intervals following global ischemia after exposure to an acute stressor. Findings from Experiment 1 demonstrated a persistent increase in GR, CRH and CRHR1 immunoreactivity (ir) at the PVN, reduced GR and CRHR1 expression in pyramidal CA1 neurons, and increased LC TH expression in ischemic rats displaying working memory errors in the radial arm Maze. Findings from Experiment 2 revealed increased CORT secretion up to 7 days, but no longer present 14 and 21 days post ischemia. However upon an acute restraint stress induced 27 days following reperfusion, ischemic rats had increased plasma CORT secretions compared to sham-operated animals, suggesting HPA axis hypersensitivity. Antalarmin (2 μg/2 μl) pretreatment significantly attenuated post ischemic elevation of basal and stress-induced CORT secretion. These findings support persistent neuroendocrine dysfunctions following brain ischemia likely to contribute to emotional and cognitive impairments observed in survivors of cardiac arrest and stroke.