Diurnal cortisol rhythm as a predictor of lung cancer survival

Sandra E. Sephton, Elizabeth Lush, Eric A. Dedert, Andrea R. Floyd, Whitney N. Rebholz, Firdaus Dhabhar, David Spiegel, Paul Salmon

Research output: Contribution to journalArticle

122 Citations (Scopus)

Abstract

Background: Poorly coordinated diurnal cortisol and circadian rest-activity rhythms predict earlier mortality in metastatic breast and colorectal cancer, respectively. We examined the prognostic value of the diurnal cortisol rhythm in lung cancer. Methods: Lung cancer patients (. n=. 62, 34 female) were within 5. years of diagnosis and had primarily non small-cell lung cancer, with disease stage ranging from early to advanced. Saliva collected over two days allowed calculation of the diurnal cortisol slope and the cortisol awakening response (CAR). Lymphocyte numbers and subsets were measured by flow cytometry. Survival data were obtained for 57 patients. Cox Proportional Hazards analyses were used to test the prognostic value of the diurnal cortisol rhythm on survival calculated both from study entry and from initial diagnosis. Results: The diurnal cortisol slope predicted subsequent survival over three years. Early mortality occurred among patients with higher slopes, or relatively " flat" rhythms indicating lack of normal diurnal variation (Cox Proportional Hazards p=. .009). Cortisol slope also predicted survival time from initial diagnosis (. p=. .012). Flattened profiles were linked with male gender (. t=. 2.04, df=. 59, p=. .046) and low total and cytotoxic T cell lymphocyte counts (. r=. -.39 and -.30, p=. .004 and .035, respectively). After adjustment for possible confounding factors, diurnal slope remained a significant, independent predictor of survival. Conclusions: Flattening of the diurnal cortisol rhythm predicts early lung cancer death. Data contribute to growing evidence that circadian disruption accelerates tumor progression.

Original languageEnglish (US)
JournalBrain, Behavior, and Immunity
Volume30
Issue numberSUPPL.
DOIs
StatePublished - Mar 15 2013
Externally publishedYes

Fingerprint

Circadian Rhythm
Hydrocortisone
Lung Neoplasms
Survival
Lymphocyte Count
Mortality
Lymphocyte Subsets
Cytotoxic T-Lymphocytes
Saliva
Non-Small Cell Lung Carcinoma
Colorectal Neoplasms
Flow Cytometry
Cell Count
Breast Neoplasms
T-Lymphocytes
Neoplasms

Keywords

  • Circadian dysregulation
  • Cortisol
  • Lung cancer

ASJC Scopus subject areas

  • Immunology
  • Endocrine and Autonomic Systems
  • Behavioral Neuroscience

Cite this

Sephton, S. E., Lush, E., Dedert, E. A., Floyd, A. R., Rebholz, W. N., Dhabhar, F., ... Salmon, P. (2013). Diurnal cortisol rhythm as a predictor of lung cancer survival. Brain, Behavior, and Immunity, 30(SUPPL.). https://doi.org/10.1016/j.bbi.2012.07.019

Diurnal cortisol rhythm as a predictor of lung cancer survival. / Sephton, Sandra E.; Lush, Elizabeth; Dedert, Eric A.; Floyd, Andrea R.; Rebholz, Whitney N.; Dhabhar, Firdaus; Spiegel, David; Salmon, Paul.

In: Brain, Behavior, and Immunity, Vol. 30, No. SUPPL., 15.03.2013.

Research output: Contribution to journalArticle

Sephton, SE, Lush, E, Dedert, EA, Floyd, AR, Rebholz, WN, Dhabhar, F, Spiegel, D & Salmon, P 2013, 'Diurnal cortisol rhythm as a predictor of lung cancer survival', Brain, Behavior, and Immunity, vol. 30, no. SUPPL.. https://doi.org/10.1016/j.bbi.2012.07.019
Sephton, Sandra E. ; Lush, Elizabeth ; Dedert, Eric A. ; Floyd, Andrea R. ; Rebholz, Whitney N. ; Dhabhar, Firdaus ; Spiegel, David ; Salmon, Paul. / Diurnal cortisol rhythm as a predictor of lung cancer survival. In: Brain, Behavior, and Immunity. 2013 ; Vol. 30, No. SUPPL.
@article{97da069eb3734c51b54f9747d7b14136,
title = "Diurnal cortisol rhythm as a predictor of lung cancer survival",
abstract = "Background: Poorly coordinated diurnal cortisol and circadian rest-activity rhythms predict earlier mortality in metastatic breast and colorectal cancer, respectively. We examined the prognostic value of the diurnal cortisol rhythm in lung cancer. Methods: Lung cancer patients (. n=. 62, 34 female) were within 5. years of diagnosis and had primarily non small-cell lung cancer, with disease stage ranging from early to advanced. Saliva collected over two days allowed calculation of the diurnal cortisol slope and the cortisol awakening response (CAR). Lymphocyte numbers and subsets were measured by flow cytometry. Survival data were obtained for 57 patients. Cox Proportional Hazards analyses were used to test the prognostic value of the diurnal cortisol rhythm on survival calculated both from study entry and from initial diagnosis. Results: The diurnal cortisol slope predicted subsequent survival over three years. Early mortality occurred among patients with higher slopes, or relatively {"} flat{"} rhythms indicating lack of normal diurnal variation (Cox Proportional Hazards p=. .009). Cortisol slope also predicted survival time from initial diagnosis (. p=. .012). Flattened profiles were linked with male gender (. t=. 2.04, df=. 59, p=. .046) and low total and cytotoxic T cell lymphocyte counts (. r=. -.39 and -.30, p=. .004 and .035, respectively). After adjustment for possible confounding factors, diurnal slope remained a significant, independent predictor of survival. Conclusions: Flattening of the diurnal cortisol rhythm predicts early lung cancer death. Data contribute to growing evidence that circadian disruption accelerates tumor progression.",
keywords = "Circadian dysregulation, Cortisol, Lung cancer",
author = "Sephton, {Sandra E.} and Elizabeth Lush and Dedert, {Eric A.} and Floyd, {Andrea R.} and Rebholz, {Whitney N.} and Firdaus Dhabhar and David Spiegel and Paul Salmon",
year = "2013",
month = "3",
day = "15",
doi = "10.1016/j.bbi.2012.07.019",
language = "English (US)",
volume = "30",
journal = "Brain, Behavior, and Immunity",
issn = "0889-1591",
publisher = "Academic Press Inc.",
number = "SUPPL.",

}

TY - JOUR

T1 - Diurnal cortisol rhythm as a predictor of lung cancer survival

AU - Sephton, Sandra E.

AU - Lush, Elizabeth

AU - Dedert, Eric A.

AU - Floyd, Andrea R.

AU - Rebholz, Whitney N.

AU - Dhabhar, Firdaus

AU - Spiegel, David

AU - Salmon, Paul

PY - 2013/3/15

Y1 - 2013/3/15

N2 - Background: Poorly coordinated diurnal cortisol and circadian rest-activity rhythms predict earlier mortality in metastatic breast and colorectal cancer, respectively. We examined the prognostic value of the diurnal cortisol rhythm in lung cancer. Methods: Lung cancer patients (. n=. 62, 34 female) were within 5. years of diagnosis and had primarily non small-cell lung cancer, with disease stage ranging from early to advanced. Saliva collected over two days allowed calculation of the diurnal cortisol slope and the cortisol awakening response (CAR). Lymphocyte numbers and subsets were measured by flow cytometry. Survival data were obtained for 57 patients. Cox Proportional Hazards analyses were used to test the prognostic value of the diurnal cortisol rhythm on survival calculated both from study entry and from initial diagnosis. Results: The diurnal cortisol slope predicted subsequent survival over three years. Early mortality occurred among patients with higher slopes, or relatively " flat" rhythms indicating lack of normal diurnal variation (Cox Proportional Hazards p=. .009). Cortisol slope also predicted survival time from initial diagnosis (. p=. .012). Flattened profiles were linked with male gender (. t=. 2.04, df=. 59, p=. .046) and low total and cytotoxic T cell lymphocyte counts (. r=. -.39 and -.30, p=. .004 and .035, respectively). After adjustment for possible confounding factors, diurnal slope remained a significant, independent predictor of survival. Conclusions: Flattening of the diurnal cortisol rhythm predicts early lung cancer death. Data contribute to growing evidence that circadian disruption accelerates tumor progression.

AB - Background: Poorly coordinated diurnal cortisol and circadian rest-activity rhythms predict earlier mortality in metastatic breast and colorectal cancer, respectively. We examined the prognostic value of the diurnal cortisol rhythm in lung cancer. Methods: Lung cancer patients (. n=. 62, 34 female) were within 5. years of diagnosis and had primarily non small-cell lung cancer, with disease stage ranging from early to advanced. Saliva collected over two days allowed calculation of the diurnal cortisol slope and the cortisol awakening response (CAR). Lymphocyte numbers and subsets were measured by flow cytometry. Survival data were obtained for 57 patients. Cox Proportional Hazards analyses were used to test the prognostic value of the diurnal cortisol rhythm on survival calculated both from study entry and from initial diagnosis. Results: The diurnal cortisol slope predicted subsequent survival over three years. Early mortality occurred among patients with higher slopes, or relatively " flat" rhythms indicating lack of normal diurnal variation (Cox Proportional Hazards p=. .009). Cortisol slope also predicted survival time from initial diagnosis (. p=. .012). Flattened profiles were linked with male gender (. t=. 2.04, df=. 59, p=. .046) and low total and cytotoxic T cell lymphocyte counts (. r=. -.39 and -.30, p=. .004 and .035, respectively). After adjustment for possible confounding factors, diurnal slope remained a significant, independent predictor of survival. Conclusions: Flattening of the diurnal cortisol rhythm predicts early lung cancer death. Data contribute to growing evidence that circadian disruption accelerates tumor progression.

KW - Circadian dysregulation

KW - Cortisol

KW - Lung cancer

UR - http://www.scopus.com/inward/record.url?scp=84875371336&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875371336&partnerID=8YFLogxK

U2 - 10.1016/j.bbi.2012.07.019

DO - 10.1016/j.bbi.2012.07.019

M3 - Article

VL - 30

JO - Brain, Behavior, and Immunity

JF - Brain, Behavior, and Immunity

SN - 0889-1591

IS - SUPPL.

ER -