Sex, pain, alcoholism and anxiety symptoms are predictive for systemic cortisol levels in oral cancer patients
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Data
2021-02-19
Autores
Figueira, Jéssica Araújo [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Pacientes com câncer podem apresentar uma desregulação do eixo hipotálamo- hipófise-adrenal (HPA) e secreção aumentada do hormônio cortisol. Níveis elevados de cortisol têm sido associados a pior prognóstico de diferentes tipos de câncer. Embora alterações psicológicas como ansiedade e depressão possam deflagrar uma secreção anormal de cortisol, pouco se sabe sobre a influência destas desordens emocionais na desregulação do eixo HPA em pacientes com câncer quando avaliadas em conjunto com variáveis demográficas, clinicopatológicas e biocomportamentais. Este estudo transversal avaliou os níveis plasmáticos de cortisol em 133 pacientes com carcinoma espinocelular (CEC) de boca e sua associação com variáveis demográficas, clínicopatológicas, biocomportamentais e psicológicas. Os níveis plasmáticos de cortisol foram mensurados por eletroquimioluminescência, e os níveis de ansiedade e depressão foram avaliados pelo Inventário de Ansiedade (BAI) e de Depressão (BDI) de Beck, respectivamente. Os dados demográficos, clinicopatológicos e biocomportamentais foram coletados dos prontuários dos pacientes. Os resultados da análise multivariada mostraram que homens com CEC de boca apresentaram 4,5 vezes mais chances de terem níveis elevados de cortisol plasmático do que as mulheres com a doença (OR=4,472; p=0,018). A presença de dor relacionada ao tumor primário também foi preditivo para maiores níveis de cortisol (OR=5,388; p=0,003). A ausência de histórico de consumo crônico de álcool foi um fator protetor para concentrações muito elevadas do hormônio nos pacientes com CEC de boca (OR=0,104; p= 0,004). Sintomas de ansiedade mensurados pelo BAI como “mãos trêmulas” (OR=0,192; p= 0,016) e estar “nervoso” (OR=0,207; p= 0,0004) foram associados a menores níveis de cortisol. Por outro lado, o sentimento de “medo de perder o controle” foi um fator de risco para níveis muito elevados de cortisol plasmático (OR=6,508; p= 0,0004). O score global e os sintomas específicos de depressão mensurados pelo BDI não foram preditivos para os níveis plasmáticos hormonais (p<0,05). Juntos, os resultados mostram que sexo, dor, consumo de álcool e sintomas de ansiedade são variáveis independentes para os níveis sistêmicos de cortisol nos pacientes com câncer de boca. Portanto, intervenção psicológica, bem como o controle da dor e do alcoolismo devem ser considerados para a prevenção dos efeitos negativos da desregulação da secreção de cortisol nos pacientes diagnosticados com câncer de boca.
Cancer patients may have a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and abnormal secretion of cortisol. Increased cortisol levels have been associated with worse prognosis in different types of cancer. Although anxiety and depression can trigger an abnormal cortisol secretion, little is known regarding the influence of these emotional disorders on HPA axis dysregulation in cancer patients when evaluating together with demographic, clinicopathological and biobehavioral variables. This cross- sectional study analyzed the plasma cortisol levels of 133 patients with oral squamous cell carcinoma (OSCC) and its association with demographic, clinicopathological, biobehavioral and psychological variables. Plasma cortisol levels were measured by electrochemiluminescence, and anxiety and depression symptoms were assessed using Beck Anxiety Inventory (BAI) and Depression (BDI), respectively. Demographic, clinicopathological and biobehavioral data were collected from patients' medical records. Results from multivariate analysis showed that men with OSCC were 4.5 times more likely to have higher plasma cortisol levels than women (OR = 4.472, p = 0.018). The presence of cancer-induced pain was predictive for higher cortisol levels (OR = 5.388, p = 0.003). The absence of chronic alcohol consumption history was a protective factor for highest hormonal concentrations in oral cancer patients (OR = 0.104, p = 0.004). Anxiety symptoms measured by BAI as "hands trembling" (OR = 0.192, p = 0.016) and being "nervous" (OR = 0.207, p = 0.0004) were associated with lower cortisol levels. In contrast, the feeling of “fear of losing control” was a risk factor for highest systemic levels cortisol (OR = 6.508, p = 0.0004). The global score and specific symptoms of depression measured by the BDI were not predictive for plasma hormone levels (p <0.05). Together, our results show that sex, pain, alcohol consumption and anxiety symptoms are independent variables for systemic cortisol levels in patients with oral cancer. Therefore, psychological intervention, as well as control of pain and alcohol consumption, should be considered to prevent the negative effects of cortisol secretion dysregulation in patients with oral cancer.
Cancer patients may have a dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and abnormal secretion of cortisol. Increased cortisol levels have been associated with worse prognosis in different types of cancer. Although anxiety and depression can trigger an abnormal cortisol secretion, little is known regarding the influence of these emotional disorders on HPA axis dysregulation in cancer patients when evaluating together with demographic, clinicopathological and biobehavioral variables. This cross- sectional study analyzed the plasma cortisol levels of 133 patients with oral squamous cell carcinoma (OSCC) and its association with demographic, clinicopathological, biobehavioral and psychological variables. Plasma cortisol levels were measured by electrochemiluminescence, and anxiety and depression symptoms were assessed using Beck Anxiety Inventory (BAI) and Depression (BDI), respectively. Demographic, clinicopathological and biobehavioral data were collected from patients' medical records. Results from multivariate analysis showed that men with OSCC were 4.5 times more likely to have higher plasma cortisol levels than women (OR = 4.472, p = 0.018). The presence of cancer-induced pain was predictive for higher cortisol levels (OR = 5.388, p = 0.003). The absence of chronic alcohol consumption history was a protective factor for highest hormonal concentrations in oral cancer patients (OR = 0.104, p = 0.004). Anxiety symptoms measured by BAI as "hands trembling" (OR = 0.192, p = 0.016) and being "nervous" (OR = 0.207, p = 0.0004) were associated with lower cortisol levels. In contrast, the feeling of “fear of losing control” was a risk factor for highest systemic levels cortisol (OR = 6.508, p = 0.0004). The global score and specific symptoms of depression measured by the BDI were not predictive for plasma hormone levels (p <0.05). Together, our results show that sex, pain, alcohol consumption and anxiety symptoms are independent variables for systemic cortisol levels in patients with oral cancer. Therefore, psychological intervention, as well as control of pain and alcohol consumption, should be considered to prevent the negative effects of cortisol secretion dysregulation in patients with oral cancer.
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Palavras-chave
Sistema hipotálamo-hipofisário, Glucocorticoides, Estresse psicológico, Ansiedade, Depressão, Neoplasias, Neoplasias de cabeça e pescoço, Neoplasias bucais, Glucocorticoids, Mouth neoplasm