Cortisol Rhythm Affects Severity of Psychoneurological Symptom Cluster in NSCLC

Flatter diurnal cortisol rhythm influences the severity of a psychoneurological symptom cluster of sleep disturbance, fatigue, anxiety, and depression in patients with advanced lung cancer, necessitating more attention to symptom management in these patients, according to a study recently published in Cancer Nursing.

Patients with advanced-stage lung cancer often have a high prevalence of physical and psychological symptoms; therefore, a team of researchers investigated the intercorrelation of symptoms within this psychoneurological symptom cluster and the factors that influence its severity.

Cortisol rhythm also was significantly associated with the psychoneurological symptom cluster and could be considered a shared mechanism that underlies the symptoms in the cluster. Changes in cortisol rhythms could affect the way that cortisol suppresses proinflammatory cytokine production, which may lead to a surge in the symptoms of the psychoneurological symptom cluster, the researchers explained.

For this study, the researchers used baseline data from 161 patients with stage IIIB or IV non-small cell lung cancer (NSCLC) who were participating in a randomized controlled trial of an exercise intervention conducted in Hong Kong.

The researchers measured sleep disturbance with the Pittsburgh Sleep Quality Index (PSQI), fatigue with the Brief Fatigue Inventory (BFI), and anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). They noted that these measurement tools have been validated in the Chinese population.

The severity of the psychoneurological symptom cluster was calculated by averaging the summary scores of fatigue, anxiety, depression, and sleep disturbance severity as there is no gold standard assessment tool for evaluating symptom clusters. Co-occurrence of the symptoms was found to be significantly correlated (P <.001).

Patients also collected saliva samples at 4 time points during the day (0.5, 4, 8, and 12 hours after usual wake time), and recorded the actual time of collection. Cortisol concentrations of the samples were determined, and diurnal cortisol slope was calculated by regressing log-transformed cortisol on the sample collection time.

Lower Karnofsky Performance Score (KPS), higher Charleston Comorbidity Index (CCI), and flatter diurnal cortisol slope significantly associated with greater severity of psychoneurological symptom cluster (P <.05). However, after adjusting for demographic (age, sex, marital status, KPS score, smoking, drinking behavior) and clinical (time since diagnosis, current treatment, and CCI) factors, a significant association between diurnal cortisol slope and psychoneurological symptom cluster remained.

“This study identified a significant correlation between sleep disturbance, fatigue, anxiety, and depression that co-occur in psychoneurological symptom cluster in patients with advanced lung cancer,” the researchers wrote.

“Interventions targeting the improvement of associated factors, such as comorbidities and physical performance status, could potentially alleviate the severity of the psychoneurological symptom cluster.”

Reference

Takemura N, Cheung DST, Fong DYT, Ho MH, Lin CC. Relationship between cortisol rhythm and psychoneurological symptom cluster in patients with advanced lung cancer. Cancer Nurs. Published August 8, 2023. doi:10.1097/NCC.0000000000001268