Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT.
Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT.
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DOI：
10.1016/j.cpnec.2022.100153
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发表时间：
2022-08
影响因子：
--
通讯作者：
Napoles, Anna Maria
中科院分区：
文献类型：
--
作者：
Samayoa, Cathy;Santana-Ufret, Veronica;Santoyo-Olsson, Jasmine;Strassle, Paula D.;Stewart, Anita;Bonilla, Jackie;Escalera, Cristian;Mendez, Rebecca Margarita;Marquez-Magana, Leticia;Ortiz, Carmen;Ceballos, Rachel M.;Napoles, Anna Maria
关键词：
与他们的白色同行相比，拉丁裔乳腺癌幸存者的生存率和健康相关的生活质量较差，抑郁和焦虑的比例较高，这可能是慢性压力的结果。慢性应激影响下丘脑-垂体-肾上腺（HPA）轴，导致皮质醇失调，这可能与乳腺癌生存有关。然而，皮质醇水平和皮质醇概况的拉丁裔乳腺癌幸存者的特点很差，由于他们在生物医学研究中的代表性不足。本研究的目的是描述参与努埃沃Amanecer-II（一种基于证据的同行提供的认知行为压力管理干预）RCT研究的农村拉丁裔乳腺癌幸存者的皮质醇水平和皮质醇分泌模式。以受试者为中心的招募和收集策略被用来获得生物标本进行皮质醇分析。在基线和6个月（干预后3个月）时获得9份唾液样本（3天/天）和1份头发样本。我们描述了皮质醇水平和配置文件，探讨生物标志物与自我报告的压力和心理困扰的措施的相关性，并比较妇女谁接受了延迟干预组的压力生物标志物的干预。平均头发皮质醇浓度（HCC）被用来评估慢性应激。基于皮质醇的日常测量（觉醒，觉醒后30分钟和就寝时间），我们计算了皮质醇觉醒反应（CAR）动态性质的三个汇总指标：1）CAR斜率，2）CAR是否表现出≥ 40的百分比变化，3）每日总皮质醇输出（AUCg）。线性和对数二项回归，占多个样本，每个参与者，被用来比较皮质醇措施在6个月的后续行动的治疗arm.Participants（n = 103）来自两个农村加州社区; 76提供至少一个唾液样本在基线和后续行动，并被纳入分析。基线时，平均年龄为57岁，自诊断以来的平均年数为2年，76%的人接受过高中或以下教育，34%的人报告经济困难。总体中位CAR斜率为0.10，中位皮质醇AUC g（以千计）为11.34（范围= 0.93，36.66）。平均毛发皮质醇浓度为1751.6 pg/mg（SD = 1148.6）。42%的样本的CAR变化≥ 40%。我们发现皮质醇测量值与自我报告的压力和心理困扰测量值之间没有统计学显著相关性。在随访时，在HCC中没有观察到差异（干预和对照之间的平均差异：− 0.11，95% CI-0.48，0.25），CAR斜率（0.001，95% CI-0.005，0.008）、皮质醇AUC g（− 0.15，95% CI-0.42，0.13）或治疗组间CAR变化≥ 40%（患病率比0.87，95% CI 0.42，1.77）。我们的研究结果表明，超过一半的样本中皮质醇水平变平，这表明在农村讲西班牙语的拉丁裔乳腺癌幸存者中存在潜在的HPA轴失调，由于其对长期生存的影响，值得进一步研究。http://www.ClinicalTrials.gov 拉丁裔乳腺癌幸存者显示皮质醇水平变平。头发皮质醇水平，一种衡量慢性压力的指标，被发现升高。压力生物标志物和自我报告的措施没有实质性的相关性。拉丁裔乳腺癌幸存者容易受到HPA轴失调的影响。
Compared to their White counterparts, Latina breast cancer survivors have poorer survival rates and health-related quality of life, and higher rates of depression and anxiety which may be a result of chronic stress. Chronic stress impacts the hypothalamic-pituitary-adrenal (HPA) axis, resulting in cortisol dysregulation which may be associated with breast cancer survival. However, cortisol levels and cortisol profiles of Latina breast cancer survivors are poorly characterized due to their underrepresentation in biomedical research. The objective of this study was to describe cortisol levels and patterns of cortisol secretions in rural Latina breast cancer survivors participating in an RCT study of Nuevo Amanecer-II, an evidence-based peer-delivered cognitive behavioral stress management intervention. Participant-centered recruitment and collection strategies were used to obtain biospecimens for cortisol analysis. Nine saliva samples (3/day for 3 days) and a hair sample were obtained at baseline and 6-months (3-months post-intervention). We describe cortisol levels and profiles, explore correlations of biomarkers with self-report measures of stress and psychological distress, and compare women who received the intervention with a delayed intervention group on biomarkers of stress. Mean hair cortisol concentration (HCC) was used to assess chronic stress. Based on daily measures of cortisol (awakening, 30 min post-awakening, and bedtime), we calculated three summary measures of the dynamic nature of the cortisol awakening response (CAR): 1) the CAR slope, 2) whether CAR demonstrates a percent change ≥40, and 3) total daily cortisol output (AUCg). Linear and log-binomial regression, accounting for multiple samples per participant, were used to compare cortisol measures at 6-month follow-up by treatment arm. Participants (n = 103) were from two rural California communities; 76 provided at least one saliva sample at baseline and follow-up and were included in the analysis. At baseline, mean age was 57 years, mean years since diagnosis was 2 years, 76% had a high school education or less, and 34% reported financial hardship. The overall median CAR slope was 0.10, and median cortisol AUCg (in thousands) was 11.34 (range = 0.93, 36.66). Mean hair cortisol concentration was 1751.6 pg/mg (SD = 1148.6). Forty-two percent of samples had a ≥40% change in CAR. We found no statistically significant correlations between the cortisol measures and self-reported measures of stress and psychological distress. At follow-up, no differences were seen in HCC (mean difference between intervention and control: −0.11, 95% CI -0.48, 0.25), CAR slope (0.001, 95% CI -0.005, 0.008), cortisol AUCg (−0.15, 95% CI -0.42, 0.13), or ≥40% change in CAR (prevalence ratio 0.87, 95% CI 0.42, 1.77) between treatment arms. Our findings of flattened cortisol profiles among more than half of the sample suggest potential HPA-axis dysregulation among rural Spanish-speaking Latina breast cancer survivors that merits further study due to its implications for long-term survival. http://www.ClinicalTrials.gov identifier NCT02931552. Latina breast cancer survivors displayed flattened cortisol profiles. Hair cortisol levels, a measure of chronic stress, were found to be elevated. Stress biomarkers and self-report measures did not substantially correlate. Latina breast cancer survivors are vulnerable to the repercussion of HPA-axis dysregulation.
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