title: Efficacy of cancer chemotherapy in relation to synchronization of cortisol rhythm, immune status and psychospiritual profile in metastatic non-small cell lung cancer.
abstract: BACKGROUND
  The prognosis of cancer and the efficacy of the various anticancer therapies depend not only on tumor characteristics, but also on the endocrine and immune status of patients. Moreover, studies have shown that the clinical course of the neoplastic disease is also influenced by the psychospiritual status of patients. It is thus probable that the influence of psychospirituality on tumor growth may be mediated by the immunoneuroendocrine system, as demonstrated by the recent advances in psychoneuroendocrinological research. However, at present there are only few data on the possible link between the psychospiritual status and immunoendocrine functions of cancer patients. This study was carried out to investigate the relationships existing among the psychospiritual profile, cortisol rhythm and lymphocyte number before and after chemotherapy, and the efficacy of chemotherapy itself in advanced cancer patients.
  
  
  METHODS
  The study included 30 consecutive metastatic non-small cell lung cancer patients under chemotherapeutic treatment with cisplatin plus gemcitabine. The psychobiological investigations consisted of lymphocyte count, cortisol circadian rhythm, psychological profile using Rorschach test, and spiritual score, as assessed by a specific clinical test for spirituality. The control group consisted of 100 healthy volunteers. The patients who achieved a tumor regression, showed a significantly higher pre-treatment lymphocyte count and significantly lower alteration of the cortisol rhythm with respect to those who had no benefit from chemotherapy. Moreover, the lymphocyte mean number increased during chemotherapy in responder patients, whereas it progressively diminished in those who had disease progression. Lymphocytopenia and alterations of the cortisol rhythm prior to chemotherapy were associated with a loss of the psychosexual identity according the Rorschach test. Moreover, the mean spiritual score was lower in patients than in controls, although the difference was not significant. Finally, a low spiritual score prior to therapy was associated with a higher frequency of lymphocytopenia and cortisol rhythm alteration, as well as with a lower efficacy of chemotherapy itself.
  
  
  CONCLUSIONS
  This preliminary study would suggest that the psychospiritual status of cancer patients may influence the efficacy of chemotherapy through the immunoneuroendocrine system.
authors.affiliation: Divisions of Radiation Oncology, San Gerardo Hospital, Monza, Milan, Italy. p.lissoni@hsgerardo.org
authors.forename: P
authors.initials: P
authors.lastname: Lissoni
authors.forename: G
authors.initials: G
authors.lastname: Messina
authors.forename: A
authors.initials: A
authors.lastname: Balestra
authors.forename: M
authors.initials: M
authors.lastname: Colciago
authors.forename: F
authors.initials: F
authors.lastname: Brivio
authors.forename: L
authors.initials: L
authors.lastname: Fumagalli
authors.forename: G
authors.initials: G
authors.lastname: Fumagalli
authors.forename: D
authors.initials: D
authors.lastname: Parolini
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000097:blood / Q000378:metabolism*; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000097:blood / Q000188:drug therapy / Q000276:immunology / Q000523:psychology*; D016022:Case-Control Studies; D002940:Circadian Rhythm / Q000502:physiology; D002945:Cisplatin / Q000627:therapeutic use; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000502:physiology*; D008175:Lung Neoplasms / Q000097:blood / Q000188:drug therapy / Q000276:immunology / Q000523:psychology*; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012392:Rorschach Test; D029181:Spirituality; D000093542:Gemcitabine
chemical_list: D000893:Anti-Inflammatory Agents; D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D003841:Deoxycytidine; D002945:Cisplatin; D006854:Hydrocortisone; D000093542:Gemcitabine