Examining Early-Life Adversity and the 'Stress Hormone' in Ovarian Cancer Survivors

Adversity early on in life and increased stress levels could impact ovarian cancer outcomes — even if these instances happen before a woman is diagnosed, according to a recent article published in the journal Cancer.

The researchers had 337 patients with suspected ovarian cancer diagnoses with a primary diagnosis of epithelial ovarian, peritoneal or fallopian tube carcinoma fill out psychosocial questionnaires at baseline, six months after they received their ovarian cancer diagnosis and then one year after. The survey included questions about acute life stressors, as well as anxiety and depression.

Participants also had their cortisol levels tested throughout the year post-diagnosis. Cortisol, which is frequently referred to as the “stress hormone” is released in reaction to inflammation and stressful stimuli. Release tends to follow a natural rhythm, peaking after a person wakes up, and then reaching its lowest point around midnight. However, stressful events can flatten the cortisol slopes.

Stress not only affects cortisol, but inflammation, too. Early-life adversities have been shown to increase inflammation and/or make an adult more prone to inflammation later on in life. It can also lead to metabolic and immune changes. Ovarian cancer cells produce inflammatory cytokines, including interleukin-6 (IL-6), which promotes the proliferation and spread of cancer cells.

“However, little is understood about the relation between prior stress exposure, anxiety symptoms and IL-6 in patients with cancer,” the researcher wrote.

To investigate this possible relationship, the researchers drew blood to measure IL-6 levels during the morning of their surgery and after six and 12 months.

Ultimately, the researchers found that while anxiety and stress exposures were not related to IL-6 levels, patients with histories of early-life adversities or who had more danger-related events in the year leading up to their diagnosis were more likely to experience anxiety and flattened cortisol slopes during that first 12 months.

“Anxiety was associated with a flatter cortisol slope over the first year postdiagnosis, suggesting greater dysregulation of a neuroendocrine hormone previously associated with cancer survival,” the researchers wrote.

Overall, there was a trend toward decreasing anxiety in ovarian cancer survivors throughout the first year. But that might make it even more important that clinicians recognize the signs of anxiety and depression in their patients who are more than a year out from diagnosis.

“Our findings of a general decrease in anxiety over time is consistent with prior research in this population and makes the persistence of anxiety in specific individuals all the more salient,” they wrote.

These findings warrant more research and focus on managing anxiety levels directly following an ovarian cancer diagnosis, according to the researchers.

“In conclusion, (early-life adversities) and prior danger events emerged as risk factors for sustained anxiety and cortisol dysregulation in patients with ovarian cancer over the first year after diagnosis,” they 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.”