Mazen Amatoury1, Ann M Maguire2, Jake Olivier3, Belinda Barton4, Melissa Gabriel5, Luciano Dalla-Pozza6, Katharine S Steinbeck7, Robert A Battisti8. 1. Cancer Centre for Children, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia; Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia. Electronic address: mama8796@uni.sydney.edu.au. 2. Cancer Centre for Children, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia; Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia. Electronic address: ann.maguire@health.nsw.gov.au. 3. School of Mathematics and Statistics, University of New South Wales, Sydney, NSW 2052, Australia. Electronic address: j.olivier@unsw.edu.au. 4. Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia. Electronic address: belinda.barton@health.nsw.gov.au. 5. Cancer Centre for Children, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia. Electronic address: melissa.gabriel@health.nsw.gov.au. 6. Cancer Centre for Children, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia. Electronic address: luciano.dallapozza@health.nsw.gov.au. 7. Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia; Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia. Electronic address: kate.steinbeck@health.nsw.gov.au. 8. Cancer Centre for Children, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia; Children's Hospital Education Research Institute, The Children's Hospital at Westmead, Locked Bag 4001, Sydney, NSW 2145, Australia. Electronic address: robert.battisti@health.nsw.gov.au.
Abstract
BACKGROUND: Symptoms of anxiety may arise from fear of cancer recurrence and memories of traumatic experiences during treatment. This study aimed to identify changes in mental health and cortisol, a biological marker of stress, associated with oncology surveillance clinic attendance. METHODS: Adolescent and young adult (AYA) survivors of childhood cancer (aged 12-30 years, N = 46) attending a survivorship clinic were recruited. The State-Trait Anxiety Inventory, an anxiety self-rating and open answer question, and salivary cortisol collections were completed two weeks before and one day before clinic, on clinic day and two weeks after. RESULTS: Trait anxiety scores were consistent with the normal population. State anxiety scores two weeks after clinic were significantly lower than baseline (p = 0.02). Cortisol diurnal slopes were flatter than baseline after clinic (p = 0.02). Evening cortisol levels were significantly higher than baseline two weeks post clinic (p = 0.02). LIMITATIONS: Combined results from biological and psychometric assessments can be difficult to interpret. Larger cohorts will further delineate cortisol pathway activity and distress in AYA cancer survivors. CONCLUSIONS: Psychometric evidence indicates that AYA survivors of childhood cancer perceive themselves to be less anxious after a survivorship clinic visit. Biological evidence, however, indicates a dysregulation of the hypothalamic-pituitary-adrenal axis which may be linked to clinic attendance. Weak correlations suggest that cortisol may not be a reliable indicator of self-perceived anxiety. This may be due to confounding lifestyle factors influencing the stress response or potential 'coping strategies' developed during past treatment experience which may, hypothetically, have masked self-perceived anxiety.
BACKGROUND: Symptoms of anxiety may arise from fear of cancer recurrence and memories of traumatic experiences during treatment. This study aimed to identify changes in mental health and cortisol, a biological marker of stress, associated with oncology surveillance clinic attendance. METHODS: Adolescent and young adult (AYA) survivors of childhood cancer (aged 12-30 years, N = 46) attending a survivorship clinic were recruited. The State-Trait Anxiety Inventory, an anxiety self-rating and open answer question, and salivary cortisol collections were completed two weeks before and one day before clinic, on clinic day and two weeks after. RESULTS: Trait anxiety scores were consistent with the normal population. State anxiety scores two weeks after clinic were significantly lower than baseline (p = 0.02). Cortisol diurnal slopes were flatter than baseline after clinic (p = 0.02). Evening cortisol levels were significantly higher than baseline two weeks post clinic (p = 0.02). LIMITATIONS: Combined results from biological and psychometric assessments can be difficult to interpret. Larger cohorts will further delineate cortisol pathway activity and distress in AYA cancer survivors. CONCLUSIONS: Psychometric evidence indicates that AYA survivors of childhood cancer perceive themselves to be less anxious after a survivorship clinic visit. Biological evidence, however, indicates a dysregulation of the hypothalamic-pituitary-adrenal axis which may be linked to clinic attendance. Weak correlations suggest that cortisol may not be a reliable indicator of self-perceived anxiety. This may be due to confounding lifestyle factors influencing the stress response or potential 'coping strategies' developed during past treatment experience which may, hypothetically, have masked self-perceived anxiety.