Can Anxiety and Early Life Adversity Affect Ovarian Cancer Outcomes?


In women with ovarian cancer, those with early life adversity and anxiety had more dysregulation of cortisol, suggesting they may be at risk for more negative outcomes.

In women with a recent ovarian cancer diagnosis, decreased anxiety was found to be associated with better regulated cortisol profiles, according to a new study. Those with early life adversity and other factors associated with anxiety had sustained anxiety and more dysregulation of cortisol, suggesting they may be at risk for more negative outcomes.

“Early life adversity has been related to subsequent impairments in both physical and mental health outcomes, and it has been demonstrated that prior exposure to stress influences an individual’s vulnerability to distress when confronted with stressors later in life,” wrote study authors led by Susan K. Lutgendorf, PhD, of the University of Iowa in Iowa City. “An estimated 29% to 38% of women who face a diagnosis of ovarian cancer report significant elevations in anxiety. However, there has been minimal focus on the risk factors for anxiety and physiologic sequelae of anxiety among patients with ovarian cancer.”

The researchers examined associations between prior life stress exposure and trajectories of anxiety, cortisol, and inflammation (measured by interleukin-6 levels). A total of 337 participants completed surveys and had blood and saliva analyzed prediagnosis, after chemotherapy (6 months), and 12 months after the diagnosis. The Life Events and Difficulties Schedule was used to assess prior experiences in a subset of 127 patients. The results were published in Cancer.

Patients had a median age of 59.7 years, and 96.4% were white. Most were diagnosed at stage III disease (61.7%), and most had high-grade disease (87.2%) and serous histology (69.7%).

Anxiety levels of the cohort decreased significantly over the course of the year following diagnosis (P < .001). Patients with early life adversity reported sustained elevations in anxiety levels (P = .033), and those who reported more danger-related events in the year prior to diagnosis also had sustained elevations in anxiety over time (P = .019).

Over that first year, decreases in anxiety were significantly associated with decreases in cortisol slope (ß = 0.092; P = .047); this indicates a more normalized pattern of diurnal cortisol as a patient’s anxiety decreased, the authors noted. Decreasing anxiety levels were not associated with changes to interleukin-6 over time (P = .091).

“The key finding of the current study is that patients with ovarian cancer who had a history of early life adversity and/or greater danger-related events in the year before diagnosis were more likely to have persistent anxiety and dysregulation of the cortisol slope during the first year after diagnosis,” the authors wrote. “Because flatter cortisol slopes have been related to poorer survival in ovarian and other cancers, the clinical implications of these findings include a renewed focus on interventions targeting anxiety among ovarian cancer survivors.”

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