Advanced Breast Cancer Patients With High Stress Levels Less Likely to Survive (dateline June 27, 2000)

For years, physicians have said that a positive outlook on life can help patients of serious diseases live longer.  According to a preliminary study published in the Journal of the National Cancer Institute, researchers have now discovered a biological marker for stress in advanced breast cancer patients that may help predict their survival.  Patients who have abnormal levels of a steroid-like compound called cortisol in their saliva may be more likely to die from breast cancer than patients with normal cortisol levels, according to the study.  Cortisol is a hormone that is released in response to stress.

Researchers studied cortisol levels of 104 women with advanced breast cancer over a three-day period.  Normally, cortisol levels follow a pattern or “slope:” in the morning, cortisol levels reach their peak and drop as the day progresses.  In the study, the researchers found that the majority of women who had abnormal “slopes” of cortisol levels (which they called a “flattened slope”) did not live as long as the women with normal cortisol levels.  

The researchers also found lower counts and suppressed activity of natural killer cells among the advanced breast cancer patients with abnormal cortisol levels.  Natural killer cells help the immune system destroy threatening cells, including cancer cells.  Women who have fewer or less active natural killer cells may experience a more rapid progression of breast cancer.  

Though the research is preliminary and needs to be confirmed in larger clinical trials, other studies have also suggested that the emotional well-being of advanced (metastatic) breast cancer patients may influence survival.  In a study published in the May-June 2000 issue of the journal, Psychosom, researchers found that “a greater quality of social support is associated with lower cortisol concentrations in women with metastatic breast cancer, which is indicative of healthier neuroendocrine functioning.”  Thus, women who are supported and comforted during breast cancer treatment may fare better.

Treatment advances are also helping to extend the survival time of women with advanced breast cancer.  Many advanced breast cancer patients are eligible to participate in clinical trials which test the effectiveness of new treatments.  Physicians encourage women with breast cancer to seek support from family and friends and also consider other means of support if needed (i.e., cancer support groups). 

Advanced breast cancer (Stage IV/metastatic) is defined as breast cancer that has spread past the breast and axillary (underarm) lymph nodes to other regions of the body (such as the bone, liver, lung, or brain).  The National Cancer Institute estimates that approximately 10% to 20% of women with metastatic breast cancer survive the disease (achieve permanent remission).  Breast self-exam, physician performed clinical breast exam, and screening mammography can help detect breast cancer early, when the chances for minimally invasive treatment and survival are the greatest. 

Additional Resources and References

• The first study discussed in this article is published in the June 21, 2000 issue of the Journal of the National Cancer Institute.  An abstract of the study is available at http://jnci.oupjournals.org/cgi/content/abstract/92/12/994
• The second study discussed in this article is published in the May-June 2000 issue of Psychosom.  An abstract of the study is available at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=
  10845347&dopt=Abstract
• To learn more about advanced (metastatic) breast cancer, please visit http://www.imaginis.com/breasthealth/metastatic.asp
• To learn more about support groups for breast cancer patients, please call the National Cancer Institute at 1.800.4.CANCER or the American Cancer Society at 1.800.ACS.2345.