Behavioural, physical, and psychological predictors of cortisol and C-reactive protein in breast cancer survivors: A longitudinal study.

BACKGROUND: Breast cancer survivors (BCS) can exhibit a dysregulation of cortisol and elevated C-reactive protein (CRP) levels post-treatment, which increase the risk of diverse health outcomes. Certain behavioural, physical, and psychological variables may help to predict cortisol and CRP levels post-treatment. The aims of this study were to: (1) describe naturally occurring changes in absolute diurnal cortisol and CRP levels over a period of 1.5 years post-treatment among BCS, (2) assess if absolute diurnal cortisol and CRP levels change in tandem, and (3) assess behavioural, physical, and psychological variables as predictors of absolute diurnal cortisol levels and CRP levels. METHODS: Capillary blood and saliva samples were collected from 201 BCS, on average, 3.5 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2-T5). At each time point, five saliva samples were collected on two nonconsecutive days: at awakening, 30 â€‹min after awakening, 2:00 p.m., 4:00 p.m., and at bedtime. At each time point, participants also completed self-report questionnaires and wore an accelerometer for seven consecutive days. Data were analyzed using multilevel modeling. RESULTS: Absolute diurnal cortisol levels did not change significantly over time. CRP levels decreased across time points (B linear â€‹= â€‹-0.31, p â€‹= â€‹.01), though the rate of decrease slowed over time (B quadratic â€‹= â€‹0.05, p â€‹= â€‹.03). Generally, greater sedentary time predicted higher overall absolute diurnal cortisol levels (B â€‹< â€‹0.01, p â€‹= â€‹.01); whereas higher physical activity (B â€‹= â€‹-0.004, p â€‹< â€‹.01), lower body mass index (B â€‹= â€‹0.10, p â€‹< â€‹.01), and lower health- and cancer-related stress (B â€‹= â€‹0.24, p â€‹= â€‹.04) predicted lower overall CRP levels. Also, lower absolute diurnal cortisol levels were evident when participants engaged in more sedentary time, as compared to their own average sedentary time (B â€‹= â€‹-0.01, p â€‹< â€‹.01). CONCLUSIONS: Results offer insight into the nature of change in diurnal cortisol and CRP levels among BCS from treatment completion onwards and offer clinical implications. Helping BCS manage their weight, reduce stress, increase physical activity participation, and decrease sedentary time as soon as possible after treatment may help to reduce physiological dysregulations, thereby lowering the risk of adverse health outcomes in this population. Further research investigating specific intervention parameters such as type, context, frequency, and intensity are warranted for the development of the most optimal interventions.

An investigation into socio-demographic-, health-, and cancer-related factors associated with cortisol and C-reactive protein levels in breast cancer survivors: a longitudinal study.

BACKGROUND: Breast cancer survivors (BCS) may exhibit dysregulated patterns of cortisol and C-reactive protein (CRP). The aims of this study were to describe BCS' cortisol and CRP levels over a 1-year period after treatment, and assess how levels relate to socio-demographic- (age, education level, marital status), health- (body mass index [BMI] category, menopausal status), and cancer-related factors (cancer stage, chemotherapy exposure, time since diagnosis). METHODS: Participants (N = 201) provided data at 3 months post-treatment (T1) and again 3, 6, 9, and 12 months later (T2-T5). At T1, participants completed self-report questionnaires and had their weight and height measured by a trained technician. At T1-T5, they provided five saliva samples at awakening, 30 min after awakening, 2:00 pm, 4:00 pm, and before bedtime on two nonconsecutive days to measure diurnal cortisol, and provided capillary whole blood to measure CRP. Data were analyzed using repeated-measure analyses of variance (ANOVAs) and mixed-design ANOVAs. RESULTS: Diurnal cortisol and CRP levels fluctuated over time. In univariate models, older age and post-menopausal status were associated with higher cortisol and CRP levels, higher cancer stage and chemotherapy were associated with lower cortisol levels, and higher BMI category was associated with higher CRP levels. In adjusted models, age was no longer associated with CRP levels and shorter time since diagnosis was significantly associated with higher CRP levels. CONCLUSIONS: Socio-demographic-, health-, and cancer-related factors may help identify BCS at risk of physiological dysregulation who need intervention. Identifying modifiable factors associated with cortisol and CRP will inform cancer care interventions.

Interpersonal capitalization moderates the associations of chronic caregiving stress and depression with inflammation.

Chronic stress and depression can enhance chronic low-grade inflammation. Interpersonal factors may buffer the impact of stress and depression on inflammation. Interpersonal capitalization is a social support process in which one discloses positive personal events and experiences to close others. Greater capitalization may attenuate the deleterious impact of chronic stress and depression. The goal of the current study was to assess whether interpersonal capitalization is associated with inflammation and whether it moderates the association of chronic stress and depression with inflammation. In this cross-sectional study of chronic caregiving stress, 222 caregiving mothers of adolescents with developmental disabilities or comparison mothers of typically developing adolescents completed a self-reported daily diary assessment of capitalization, the Center for Epidemiological Study-Depression scale, and provided blood samples to assess interleukin-6, tumor necrosis factor-α, and C-reactive protein, three circulating inflammatory markers. Regression analysis indicated that there was no main effect of capitalization on inflammation, p = .24, R2 = .006. However, there was a significant three-way interaction among capitalization, chronic caregiving stress, and depressive symptoms, p = .01, R2 = .02. Among participants with lower capitalization, greater depressive symptoms were associated with higher inflammation in the caregiving group, but not in the comparison group. Among participants with higher capitalization, greater depressive symptoms were no longer significantly associated with higher inflammation among caregivers, but were marginally related to inflammation in the comparison group. Capitalization may thus be an interpersonal process mitigating the effects of chronic stress and depression on inflammation.

Developmental regulation before and after a developmental deadline: the sample case of "biological clock" for childbearing.

This quasi-experimental research investigates developmental regulation around a critical life-span transition, the "biological clock" for childbearing. The action-phase model of developmental regulation proposes contrasting control orientations in individuals approaching versus those having passed a developmental deadline. Individuals in an urgency phase close to the deadline should be invested in goal pursuit, whereas those who have passed the deadline without attaining the goal should focus on goal disengagement and self-protection. In 2 studies, women at different ages and with or without children were compared with regard to various indicators of primary and secondary control striving for goal attainment versus goal disengagement and self-protection. Findings support the action-phase model of developmental regulation. Patterns of control striving congruent with the participants' status as pre- versus postdeadline were associated with superior psychological well-being.

Primary and secondary control strategies for managing health and financial stress across adulthood.

The study examined the relation among three types of control strategies (persistence, positive reappraisals, lowering aspirations) and subjective well-being across adulthood (N = 3,490). Specifically, the authors investigated whether age-adapted endorsement of control strategies is conducive to subjective well-being if individuals experience health or financial stress. The results reveal an overall enhanced reliance on control strategies in older as compared with younger adults. In addition, persistence showed a stronger positive relation to subjective well-being in young adulthood as compared with old age. In midlife and old age, positive reappraisals had a stronger positive relation to subjective well-being than persistence. Lowering aspirations was negatively related to subjective well-being, independent of age. Age differences in the relation of control strategies to subjective well-being were particularly salient in individuals who faced either health or financial stress.