title: Altered cortisol response to psychologic stress in breast cancer survivors with persistent fatigue.
abstract: OBJECTIVE
  Fatigue is one of the most common and distressing symptoms experienced by cancer patients and survivors. However, the etiology of cancer-related fatigue has not been determined. In previous studies, we have shown alterations in morning serum cortisol levels and diurnal cortisol rhythms in fatigued breast cancer survivors compared with nonfatigued control subjects. The purpose of the current study was to evaluate cortisol responses to an experimental psychologic stressor in fatigued and nonfatigued survivors.
  
  
  METHODS
  Participants included 27 breast cancer survivors (11 fatigued, 16 nonfatigued). All had completed cancer treatment at least 3 years previously and were currently healthy with no evidence of recurrence. A standardized laboratory stressor, the Trier Social Stress Test (TSST), was administered during a 90-minute afternoon session. Saliva samples and autonomic measures (heart rate, blood pressure) were collected at 15-minute intervals throughout the session.
  
  
  RESULTS
  Fatigued survivors showed a significantly blunted cortisol response to the stressor compared with nonfatigued survivors, controlling for depression and other potential confounds (p <.05). No differences in autonomic measures were observed.
  
  
  CONCLUSIONS
  These results, together with our earlier findings, suggest a dysregulation in hypothalamic-pituitary-adrenal (HPA) axis responsiveness among breast cancer survivors with enduring fatigue. Although the sample size was small, results suggest that attention to the HPA axis may be important for understanding cancer-related fatigue.
authors.affiliation: Cousins Center for Psychoneuroimmunology, UCLA Neuropsychiatric Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. jbower@ucla.edu
authors.forename: Julienne E
authors.initials: JE
authors.lastname: Bower
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Ganz
authors.forename: Najib
authors.initials: N
authors.lastname: Aziz
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D002940:Circadian Rhythm / Q000502:physiology; D015897:Comorbidity; D005221:Fatigue / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis* / Q000378:metabolism; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000175:diagnosis / Q000378:metabolism / Q000523:psychology*; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D006854:Hydrocortisone