Diurnal cortisol levels affect breast ca survival: metastatic disease.(Gynecology)

WAIKOLOA, HAWAII -- Supportive-expressive group therapy helps emotionally constrained women with metastatic breast cancer handle their negative feelings, an ability that has been linked to maintenance of normal diurnal cortisol patterns, Dr. David Spiegel reported.

Patients with metastatic breast cancer who maintain normal diurnal salivary cortisol patterns, as opposed to flat diurnal patterns, have been shown to have longer survival times, he said at a meeting sponsored by the International College of Psychosomatic Medicine.

"Getting patients to deal directly with these emotions is helpful psychologically and physiologically," Dr. Speigel said, in reporting on long-term research into the connections between stress levels and outcome in metastatic breast cancer.

Dr. Spiegel of the department of psychiatry and behavioral sciences at Stanford (Calif.) University stressed that "disease causes stress, but stress also causes disease," an observation increasingly verified through physiologic measures of distress and illness.

Metastatic breast cancer is a good model for the psychosomatic relationship because its impact is so profound that a third of patients meet criteria for posttraumatic stress disorder.

In one study, diurnal salivary cortisol was measured over a 24-hour period in 104 metastatic breast cancer patients. Just a third of the group had normal circadian patterns--a steep rise in the morning followed by a leveling off during the day.

Most patients had abnormal, flat patterns that have been associated with ...