Salivary cortisol reveals overt and hidden anxiety in survivors of childhood cancer attending clinic

• Published in: Journal of affective disorders 2018-11, Vol.240, p.105-112
• Main Authors: Amatoury, Mazen, Maguire, Ann M., Olivier, Jake, Barton, Belinda, Gabriel, Melissa, Dalla-Pozza, Luciano, Steinbeck, Katharine S., Battisti, Robert A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Ambulatory Care - psychology; Anxiety; Anxiety - metabolism; Anxiety - psychology; Cancer; Cancer Survivors - psychology; Child; Circadian Rhythm; Cortisol; Female; Humans; Hydrocortisone - metabolism; Hypothalamo-Hypophyseal System - metabolism; Male; Personality Inventory; Pituitary-Adrenal System - metabolism; Saliva - metabolism; Young Adult
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2018.07.035

•Survivors of childhood cancer perceived themselves to be less anxious after clinic.•Cortisol indicates dysregulation of stress feedback system linked to clinic visit.•Coping strategies may mask perceived anxiety and weaken correlations with cortisol.•Cortisol may not be a reliable biological marker of self-perceived anxiety. Symptoms of anxiety may arise from fear of cancer recurrence and memories of traumatic experiences during treatment. This study aimed to identify changes in mental health and cortisol, a biological marker of stress, associated with oncology surveillance clinic attendance. Adolescent and young adult (AYA) survivors of childhood cancer (aged 12–30 years, N = 46) attending a survivorship clinic were recruited. The State-Trait Anxiety Inventory, an anxiety self-rating and open answer question, and salivary cortisol collections were completed two weeks before and one day before clinic, on clinic day and two weeks after. Trait anxiety scores were consistent with the normal population. State anxiety scores two weeks after clinic were significantly lower than baseline (p = 0.02). Cortisol diurnal slopes were flatter than baseline after clinic (p = 0.02). Evening cortisol levels were significantly higher than baseline two weeks post clinic (p = 0.02). Combined results from biological and psychometric assessments can be difficult to interpret. Larger cohorts will further delineate cortisol pathway activity and distress in AYA cancer survivors. Psychometric evidence indicates that AYA survivors of childhood cancer perceive themselves to be less anxious after a survivorship clinic visit. Biological evidence, however, indicates a dysregulation of the hypothalamic-pituitary-adrenal axis which may be linked to clinic attendance. Weak correlations suggest that cortisol may not be a reliable indicator of self-perceived anxiety. This may be due to confounding lifestyle factors influencing the stress response or potential ‘coping strategies’ developed during past treatment experience which may, hypothetically, have masked self-perceived anxiety.