Skip to main content

Advertisement

Log in

Associations among Salivary Cortisol, Melatonin, Catecholamines, Sleep Quality and Stress in Women with Breast Cancer and Healthy Controls

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Dysregulations in several biological systems in breast cancer patients have been reported, including abnormalities in endocrine and sympathetic nervous system indices, as well as psychological disturbances and sleep disorders. The purpose of this exploratory study was to compare women with breast cancer to healthy control women on measures of salivary cortisol, urinary catecholamines, overnight urinary melatonin, and self-reported sleep quality, symptoms of stress, depression, anxiety and mood disturbance, to determine if discernable patterns of dysregulations across systems were apparent. Thirty-three women were tested in each group, with an average age of approximately 52 years, primarily Caucasian and well-educated. Forty percent of the women with breast cancer had stage 2 disease and they were an average of 1.36 years post-diagnosis. Women with breast cancer had significantly higher levels of disturbance on all the psychological indices, but there were no differences between groups on any of the biological measures, with the exception that the control women had higher dopamine values than the participants with breast cancer. None of the psychological scores were correlated with the biological measures. These results are consistent with other studies of early-stage breast cancer and highlight the importance of considering disease characteristics when investigating endocrine and sympathetic nervous system functioning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

REFERENCES

  • Abercrombie, H. C., Giese-Davis, J., Sephton, S., Epel, E. S., Turner-Cobb, J. M., and Spiegel, D. (2004). Flattened cortisol rhythms in metastatic breast cancer patients. psychoneuroendocrinology 29: 1082–1092.

    Article  PubMed  Google Scholar 

  • Andersen, B. L., Kiecolt-Glaser, J. K., and Glaser, R. (1994). A biobehavioral model of cancer stress and disease course. Am. Psychol. 49: 389–404.

    Article  PubMed  Google Scholar 

  • Antoni, M. H. (2003). Psychoneuroendocrinology and psychoneuroimmunology of cancer: Plausible mechanisms worth pursuing? Brain Behav. Immun. 17(1): S84–S91.

    Article  PubMed  Google Scholar 

  • Bettermann, H., Kroz, M., Girke, M., and Heckmann, C. (2001). Heart rate dynamics and cardiorespiratory coordination in diabetic and breast cancer patients. Clin. Physiol. 21: 411–420.

    Article  PubMed  Google Scholar 

  • Bovbjerg, D. H. (2003). Circadian disruption and cancer: sleep and immune regulation. Brain Behav. Immun. 17(1): S48–S50.

    Article  PubMed  Google Scholar 

  • Bower, J. E., Ganz, P. A., Aziz, N., and Fahey, J. L. (2002). Fatigue and proinflammatory cytokine activity in breast cancer survivors. Psychosom. Med 64: 604–611.

    PubMed  Google Scholar 

  • Bower, J. E., Ganz, P. A., Dickerson, S. S., Petersen, L., Aziz, N., and Fahey, J. L. (2005). Diurnal cortisol rhythm and fatigue in breast cancer survivors. Psychoneuroendocrinology 30: 92–100.

    Article  PubMed  Google Scholar 

  • Bubenik, G. A., Blask, D. E., Brown, G. M., Maestroni, G. J., Pang, S. F., Reiter, R. J., et al. (1998). Prospects of the clinical utilization of melatonin. Biol. Signals Recep. 7: 195–219.

    Article  Google Scholar 

  • Buysse, D. J., Reynolds, C. F., Monk, T. H., and Berman, S. R. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatr. Res. 28: 193–213.

    Article  Google Scholar 

  • Carlson, L. E., and Garland, S. N. (2005). Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients. Int. J. Behav. Med. 12: 278–285.

    Article  PubMed  Google Scholar 

  • Carlson, L. E., Speca, M., Patel, K. D., and Goodey, E. (2003). Mindfulness-based stress reduction in relations to quality of life, mood, symptoms and stress and immune parameters in breast and prostate cancer outpatients. Psychosom. Med. 65: 571–581.

    Article  PubMed  Google Scholar 

  • Carlson, L. E., Speca, M., Patel, K. D., and Goodey, E. (2004). Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone-Sulftate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendocrinology 29: 448–474.

    Article  PubMed  Google Scholar 

  • Carpenter, J. S., and Andrykowski, M. A. (1998). Psychometric evaluation of the Pittsburgh Sleep Quality Index. J. Psychosom. Res 45: 5–13.

    Article  PubMed  Google Scholar 

  • Cassileth, B. R., Lusk, E. J., Strouse, T. B., Miller, D. S., Brown, L. L., and Cross, P. A. (1985). A psychological analysis of cancer patients and their next-of-kin. Cancer 55: 72–76.

    Article  PubMed  Google Scholar 

  • Chambers, M. J., and Kim, J. Y. (1993). The role of state-trait anxiety in insomnia and daytime restedness. Behav. Med. 19: 42–46.

    Article  PubMed  Google Scholar 

  • Claghorn, J. L., Mathew, R. J., Weinman, M. L., and Hruska, N. (1981). Daytime sleepiness in depression. J. Clin. Psychiatr. 42: 342–343.

    Google Scholar 

  • Cohen, S., and Williamson, G. M. (1991). Stress and infectious diseases in humans. Psychol. Bull. 109: 5–24.

    Article  PubMed  Google Scholar 

  • Cowan, M. J., Graham, K. Y., and Cochrane, B. L. (1992). Comparison of a theory of quality of life between myocardial infarction and malignant melanoma: a pilot study. Progr. Cardiovasc. Nurs. 7: 18–28.

    Google Scholar 

  • Davidson, R., and MacKinnon, J. G. (1993). Estimation and Inference in Econometrics. Oxford University Press Oxford, England.

    Google Scholar 

  • Davis, S., Mirick, D. K., and Stevens, R. G. (2001). Night shift work, light at night, and risk of breast cancer. J. Nati. Cancer Inst. 93: 1557–1562.

    Article  Google Scholar 

  • Drafta, D. S., Stroe, E., Schindler, E. E., Teodosiu, T., Gozariu, L., and Drafta, D. (1981). Adrenal function in early and metastatic breast cancer: dexamethasone suppression of plasma cortisol. Endocrinologie 19: 115–121.

    PubMed  Google Scholar 

  • Edwards, S., Hucklebridge, F., Clow, A., and Evans, P. (2003). Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress. Psychosom. Med. 65: 320–327.

    Article  PubMed  Google Scholar 

  • Geoffriau, M., Brun, J., Chazot, G., and Claustrat, B. (1998). The physiology and pharmacology of melatonin in humans. Horm. Res. 49: 136–141.

    Article  PubMed  Google Scholar 

  • Gold, S. M., Zakowski, S. G., Valdimarsdottir, H. B., and Bovbjerg, D. H. (2003). Stronger endocrine responses after brief psychological stress in women at familial risk of breast cancer. Psychoneuroendocrinology 28: 584–593.

    Article  PubMed  Google Scholar 

  • Hall, M., Buysse, D. J., Nowell, P. D., Nofzinger, E. A., Houck, P., Reynolds, C. F., III, et al. (2000). Symptoms of stress and depression as correlates of sleep in primary insomnia. Psychosom. Med. 62: 227–230.

    PubMed  Google Scholar 

  • Hays, J. H., and O’Brian, J. T. (1989). Endocrine and metabolic function in patients with neoplastic disease. In Herberman, R. B. (Ed.), Influence of the Host on Tumor Development (pp. 530–543). Kluwer Academic Publishers, Dordrecht.

    Google Scholar 

  • Hewitt, M., Rowland, J. H., and Yancik, R. (2003). Cancer survivors in the United States: age, health, and disability. J. Gerontol. A Biol. Sci. Med. Sci. 58: 82–91.

    PubMed  Google Scholar 

  • Hossain, J. L., and Shapiro, C. M. (2002). The prevalence, cost implications, and management of sleep disorders: an overview. Sleep Breath. 6: 85–102.

    Article  PubMed  Google Scholar 

  • James, G. D., Berge-Landry, H. H., Valdimarsdottir, H. B., Montgomery, G. H., and Bovbjerg, D. H. (2004). Urinary catecholamine levels in daily life are elevated in women at familial risk of breast cancer. Psychoneuroendocrinology 29: 831–838.

    Article  PubMed  Google Scholar 

  • James, G. D., Sealey, J. E., Alderman, M., Ljungman, S., Mueller, F. B., Pecker, M. S., et al. (1988). A longitudinal study of urinary creatinine and creatinine clearance in normal subjects. Race, sex, and age differences. Am. J. Hypertens 1: 124–131.

    PubMed  Google Scholar 

  • Kajimura, N., Kato, M., Sekimoto, M., Watanabe, T., Takahashi, K., Okuma, T., et al. (1998). A polysomnographic study of sleep patterns in normal humans with low- or high-anxiety personality traits. Psychiatr. Clin. Neurosci. 52: 317–320.

    Article  Google Scholar 

  • Kirschbaum, C., and Hellhammer, D. H. (1994). Salivary cortisol in psychoneuroendocrine research: recent developments and applications. Psychoneuroendocrinology 19: 313–333.

    Article  PubMed  Google Scholar 

  • Koopman, C., Nouriani, B., Erickson, V., Anupindi, R., Butler, L. D., Bachmann, M. H., et al. (2002). Sleep disturbances in women with metastatic breast cancer. Breast J. 8: 362–370.

    Article  PubMed  Google Scholar 

  • Kripke, D. F., Garfinkel, L., Wingard, D. L., Klauber, M. R., and Marler, M. R. (2002). Mortality associated with sleep duration and insomnia. Archives Gen. Psychiatr. 59: 131–136.

    Article  Google Scholar 

  • Kushida, C. A., Nichols, D. A., Simon, R. D., Young, T., Grauke, J. H., Britzmann, J. B., et al. (2000). Symptom-Based Prevalence of Sleep Disorders in an Adult Primary Care Population. Sleep Breath. 4: 9–14.

    Article  PubMed  Google Scholar 

  • Leckie, M. S., and Thompson, E. (1979). Symptoms of Stress Inventory. University of Washington. Ref Type: Serial (Book,Monograph), Seattle, WA.

    Google Scholar 

  • Linsell, C. R., Lightman, S. L., Mullen, P. E., Brown, M. J., and Causon, R. C. (1985). Circadian rhythms of epinephrine and norepinephrine in man. J. Clin. Endocrinol. Metab 60: 1210–1215.

    Article  PubMed  Google Scholar 

  • Lissoni, P., Barni, S., Mandala, M., Ardizzoia, A., Paolorossi, F., Vaghi, M., et al. (1999a). Decreased toxicity and increased efficacy of cancer chemotherapy using the pineal hormone melatonin in metastatic solid tumour patients with poor clinical status. Eur. J. Cancer 35: 1688–1692.

    Article  PubMed  Google Scholar 

  • Lissoni, P., Cazzaniga, M., Tancini, G., Scardino, E., Musci, R., Barni, S., et al. (1997). Reversal of clinical resistance to LHRH analogue in metastatic prostate cancer by the pineal hormone melatonin: Efficacy of LHRH analogue plus melatonin in patients progressing on LHRH analogue alone. Eur. Urology 31: 178–181.

    Google Scholar 

  • Lissoni, P., Tancini, G., Paolorossi, F., Mandala, M., Ardizzoia, A., Malugani, F., et al. (1999b). Chemoneuroendocrine therapy of metastatic breast cancer with persistent thrombocytopenia with weekly low-dose epirubicin plus melatonin: a phase II study. J Pineal Res. 26: 169–173.

    Article  PubMed  Google Scholar 

  • Lutgendorf, S. K., and Costanzo, E. S. (2003). Psychoneuroimmunology and health psychology: an integrative model. Brain Behav. Immun. 17: 225–232.

    Article  PubMed  Google Scholar 

  • Marshall, G. D., Jr., Agarwal, S. K., Lloyd, C., Cohen, L., Henninger, E. M., and Morris, G. J. (1998). Cytokine dysregulation associated with exam stress in healthy medical students. Brain Behav. Immun. 12: 297–307.

    Article  PubMed  Google Scholar 

  • McNair, D. A., Lorr, M., and Droppelman, L. F. (1971). Profile of Mood States . Educational and Industrial Testing Service, San Diego.

    Google Scholar 

  • Mormont, M. C., and Levi, F. (1997). Circadian-system alterations during cancer processes: a review. Int J Cancer, 70 : 241–247.

    Article  PubMed  Google Scholar 

  • Pollack, L. A., Greer, G. E., Rowland, J. H., Miller, A., Doneski, D., Coughlin, S. S., et al. (2005). Cancer survivorship: a new challenge in comprehensive cancer control. Cancer Causes Control 16(1): 51–59.

    Article  PubMed  Google Scholar 

  • Porter, L. S., Mishel, M., Neelon, V., Belyea, M., Pisano, E., and Soo, M. S. (2003). Cortisol levels and responses to mammography screening in breast cancer survivors: a pilot study. Psychosom. Med. 65: 842–848.

    Article  PubMed  Google Scholar 

  • Pruessner, J. C., Kirschbaum, C., Meinlschmid, G., and Hellhammer, D. H. (2003). Two formulas for computation of the area under the curve represent measures of total hormone concentration versus time-dependent change. Psychoneuroendocrinology 28: 916–931.

    Article  PubMed  Google Scholar 

  • Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Appl. Psychol. Measurement 1: 385–401.

    Google Scholar 

  • Saez, M. C., Barriga, C., Garcia, J. J., Rodriguez, A. B., Masot, J., Duran, E., et al. (2005). Melatonin increases the survival time of animals with untreated mammary tumours: neuroendocrine stabilization. Mol. Cell Biochem. 278: 15–20.

    Article  PubMed  Google Scholar 

  • Savard, J., and Morin, C. M. (2001). Insomnia in the context of cancer: a review of a neglected problem. J. Clin. Oncol. 19: 895–908.

    PubMed  Google Scholar 

  • Savard, J., Simard, S., Blanchet, J., Ivers, H., and Morin, C. M. (2001). Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24: 583–590.

    PubMed  Google Scholar 

  • Schernhammer, E. S., Laden, F., Speizer, F. E., Willett, W. C., Hunter, D. J., Kawachi, I., et al. (2001). Rotating night shifts and risk of breast cancer in women participating in the nurses’ health study. J. Nati. Cancer Institute 93: 1563–1568.

    Google Scholar 

  • Sephton, S., and Spiegel, D. (2003). Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to disease? Brain Behav. Immun. 17: 321–328.

    Article  PubMed  Google Scholar 

  • Sephton, S. E., Sapolsky, R. M., Kraemer, H. C., and Spiegel, D. (2000). Diurnal cortisol rhythm as a predictor of breast cancer survival. J. Nati. Cancer Inst. 92: 944–1000.

    Google Scholar 

  • Shapiro, S. L., Bootzin, R. R., Figueredo, A. J., Lopez, A. M., and Schwartz, G. E. (2003). The efficacy of mindfulness-based stress reduction in the treatment of sleep disturbance in women with breast cancer: an exploratory study. J. Psychosom. Res. 54: 85–91.

    Article  PubMed  Google Scholar 

  • Shapiro, S. L. (2001). Quality of life and breast cancer: Relationship to psychosocial variables. J. Clin. Psychol. 57: 501–519.

    Article  PubMed  Google Scholar 

  • Sikes, C. R. A., and Lasley, B. J. (1989). Cognitive sequelae of hypothalamic-pituitary-adrenal (HPA) dysregulation in depression. Biol. Psychiatr. 25: 148A–149A.

    Article  Google Scholar 

  • Speca, M., Carlson, L. E., Goodey, E., and Angen, M. (2000). A randomized, wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients. Psychosom. Med. 62: 613–622.

    PubMed  Google Scholar 

  • Speilberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory: STAI (Form Y). Consulting Psychologists Press, Palo Alto, CA.

    Google Scholar 

  • Spiegel, D., and Sephton, S. E. (2001). Psychoneuroimmune and endocrine pathways in cancer: effects of stress and support. Semin. Clini. Neuropsychiatr. 6: 252–265.

    Article  Google Scholar 

  • Spiegel, D., Sephton, S. E., Terr, A. I., and Sittes, D. P. (1998). Effects of psychosocial treatment in prolonging cancer survival may be mediated by neuroimmune pathways. Ann. New York Acad. Sci. 840: 674–683.

    Article  Google Scholar 

  • Tamarkin, L., Danforth, D., Lichter, A., DeMoss, E., Cohen, M., Chabner, B., et al. (1982). Decreased nocturnal plasma melatonin peak in patients with estrogen receptor positive breast cancer. Science 216: 1003–1005.

    Article  PubMed  Google Scholar 

  • Ticher, A., Haus, E., Ron, I. G., Sackett-Lundeen, L., and Ashkenazi, I. E. (1996). The pattern of hormonal circadian time structure (acrophase) as an assessor of breast-cancer risk. Int. J. Cancer 65: 591–593.

    Article  PubMed  Google Scholar 

  • Touitou, Y., Bogdan, A., Levi, F., Benavides, M., and Auzeby, A. (1996). Disruption of the circadian patterns of serum cortisol in breast and ovarian cancer patients: relationships with tumour marker antigens. Br. J. Cancer 74: 1248–1252.

    PubMed  Google Scholar 

  • Turner-Cobb, J. M., Sephton, S. E., Koopman, C., Blake-Mortimer, J., and Spiegel, D. (2000). Social support and salivary cortisol in women with metastatic breast cancer. Psychosom. Med. 62: 337–345.

    PubMed  Google Scholar 

  • van Der Pompe, G., Antoni, M. H., and Heijnen, C. J. (1996). Elevated basal cortisol levels and attenuated ACTH and cortisol responses to a behavioral challenge in women with metastatic breast cancer. Psychoneuroendocrinology 21: 361–374.

    Article  PubMed  Google Scholar 

  • Vedhara, K., Miles, J., Bennett, P., Plummer, S., Tallon, D., Brooks, E., et al. (2003). An investigation into the relationship between salivary cortisol, stress, anxiety and depression. Biol. Psychol. 62: 89–96.

    Article  PubMed  Google Scholar 

  • Vedhara, K., Stra, J. T., Miles, J. N., Sanderman, R., and Ranchor, A. V. (2006). Psychosocial factors associated with indices of cortisol production in women with breast cancer and controls. Psychoneuroendocrinology, 31: 299–311.

    Article  PubMed  Google Scholar 

  • Vijayalaxmi, Meltz, M. L., Reiter, R. J., and Herman, T. S. (1999). Melatonin and protection from genetic damage in blood and bone marrow: whole-body irradiation studies in mice. J. Pineal Res. 27: 221–225.

  • Vijayalaxmi, Reiter, R. J., Meltz, M. L., and Herman, T. S. (1998). Melatonin: possible mechanisms involved in its ‘radioprotective’ effect. Mutation Res. 404: 187–189.

  • Vijayalaxmi, Thomas, C. R., Jr., Reiter, R. J., and Herman, T. S. (2002). Melatonin: from basic research to cancer treatment clinics. J Clin. Oncology 20: 2575–2601.

  • White, I. R., Brunner, E. J., and Barron, J. L. (1995). A comparison of overnight and 24 hour collection to measure urinary catecholamines. J. Clin. Epidemiology 48: 263–267.

    Article  Google Scholar 

  • Wolkowitz, O. M. (1994). Prospective controlled studies of the behavioral and biological effects of exogenous corticosteroids. Psychoneuroendocrinology 3: 233–255.

    Article  Google Scholar 

Download references

ACKNOWLEDGMENTS

Dr. Linda Carlson is funded by a Canadian Institutes of Health Research New Investigator Award. This project was funded by a Canadian Breast Cancer Research Alliance Developmental and Exploratory Grant. Sheila Garland was supported by a CIHR New Investigator Research Allowance awarded to Dr. Carlson. We would like to thank all the women who devoted so much time and energy to participating in this study despite also coping with the demands of cancer survivorship and daily living.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Linda E. Carlson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carlson, L.E., Campbell, T.S., Garland, S.N. et al. Associations among Salivary Cortisol, Melatonin, Catecholamines, Sleep Quality and Stress in Women with Breast Cancer and Healthy Controls. J Behav Med 30, 45–58 (2007). https://doi.org/10.1007/s10865-006-9082-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-006-9082-3

KEY WORDS

Navigation