Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT
Background: 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, re...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-08-01
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| Series: | Comprehensive Psychoneuroendocrinology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666497622000443 |
| _version_ | 1818537410280030208 |
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| author | Cathy Samayoa Veronica Santana-Ufret Jasmine Santoyo-Olsson Paula D. Strassle Anita Stewart Jackie Bonilla Cristian Escalera Rebecca Margarita Mendez Leticia Márquez-Magaña Carmen Ortiz Rachel M. Ceballos Anna Maria Nápoles |
| author_facet | Cathy Samayoa Veronica Santana-Ufret Jasmine Santoyo-Olsson Paula D. Strassle Anita Stewart Jackie Bonilla Cristian Escalera Rebecca Margarita Mendez Leticia Márquez-Magaña Carmen Ortiz Rachel M. Ceballos Anna Maria Nápoles |
| author_sort | Cathy Samayoa |
| collection | DOAJ |
| description | Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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. Trial registration: http://www.ClinicalTrials.gov identifier NCT02931552. |
| first_indexed | 2024-12-11T18:50:26Z |
| format | Article |
| id | doaj.art-6e4f98e5725f408d9779eb383be076f3 |
| institution | Directory Open Access Journal |
| issn | 2666-4976 |
| language | English |
| last_indexed | 2024-12-11T18:50:26Z |
| publishDate | 2022-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Comprehensive Psychoneuroendocrinology |
| spelling | doaj.art-6e4f98e5725f408d9779eb383be076f32022-12-22T00:54:18ZengElsevierComprehensive Psychoneuroendocrinology2666-49762022-08-0111100153Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCTCathy Samayoa0Veronica Santana-Ufret1Jasmine Santoyo-Olsson2Paula D. Strassle3Anita Stewart4Jackie Bonilla5Cristian Escalera6Rebecca Margarita Mendez7Leticia Márquez-Magaña8Carmen Ortiz9Rachel M. Ceballos10Anna Maria Nápoles11Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., San Francisco, CA, 94143, USA; Health & Equity Research Lab, Department of Biology, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA; Corresponding author. Department of Biology San Francisco State University, 1600 Holloway Ave Hensill Hall 665, San Francisco, CA, 94132, USA.Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USADivision of General Internal Medicine, Department of Medicine, University of California San Francisco (UCSF), 3333 California St., Suite 335, San Francisco, CA, 94143, USADivision of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USAUniversity of California San Francisco, Institute for Health & Aging, Center for Aging in Diverse Communities, 490 Illinois Street, 12th Floor, Box 0646, San Francisco, CA, USA, 94158Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USADivision of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USAHealth & Equity Research Lab, Department of Biology, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USAHealth & Equity Research Lab, Department of Biology, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USACírculo de Vida Cancer Support and Resource Center, 2601 Mission St, Suite 702, San Francisco, CA, 94110, USAFred Hutchinson Cancer Research Center, 1100 Fairview Ave, Seattle, WA, 98109, USADivision of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, Bethesda, MD, 20892, USABackground: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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. Trial registration: http://www.ClinicalTrials.gov identifier NCT02931552.http://www.sciencedirect.com/science/article/pii/S2666497622000443CortisolCortisol awakening responseStressBiomarkersBreast cancerHispanic/latina |
| spellingShingle | Cathy Samayoa Veronica Santana-Ufret Jasmine Santoyo-Olsson Paula D. Strassle Anita Stewart Jackie Bonilla Cristian Escalera Rebecca Margarita Mendez Leticia Márquez-Magaña Carmen Ortiz Rachel M. Ceballos Anna Maria Nápoles Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT Comprehensive Psychoneuroendocrinology Cortisol Cortisol awakening response Stress Biomarkers Breast cancer Hispanic/latina |
| title | Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT |
| title_full | Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT |
| title_fullStr | Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT |
| title_full_unstemmed | Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT |
| title_short | Cortisol levels in rural Latina breast cancer survivors participating in a peer-delivered cognitive-behavioral stress management intervention: The Nuevo Amanecer-II RCT |
| title_sort | cortisol levels in rural latina breast cancer survivors participating in a peer delivered cognitive behavioral stress management intervention the nuevo amanecer ii rct |
| topic | Cortisol Cortisol awakening response Stress Biomarkers Breast cancer Hispanic/latina |
| url | http://www.sciencedirect.com/science/article/pii/S2666497622000443 |
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