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High Perceived Stress Is Linked to Afternoon Cortisol Levels and Greater Symptom Distress in Patients With Localized Prostate Cancer

Hsiao, Chao-Pin PhD; Moore, Ida M. DNSc; Insel, Kathleen C. PhD; Merkle, Carrie J. PhD

doi: 10.1097/NCC.0b013e31820a5943

Background: Patients treated with radical prostatectomy (RP) or radiation therapy (RT) for prostate cancer can experience stress and symptoms that impact quality of life.

Objective: The objectives of this study were to describe cortisol levels, perceived stress, symptoms, and symptom distress; compare differences in variables measured between RP and RT; and identify associations among cortisol levels, perceived stress, symptoms, and symptom distress in patients treated for localized prostate cancer.

Methods: A descriptive, cross-sectional study was conducted with 53 patients (RP n = 24, RT n = 29). Data from saliva, questionnaires, and interviews were collected within 3 months of treatment. Saliva samples were collected at 4 times over 2 consecutive days. Data were analyzed using descriptive statistics, correlations, and regressions.

Results: A robust diurnal rhythm of cortisol secretion with heightened levels in the early morning and lowered levels late in the day was found. On average, the entire sample had moderate symptoms and symptom distress for urinary, bowel, and sexual dysfunction. The RP group reported significantly more urinary and sexual dysfunction symptoms and fewer bowel symptoms than did the RT group. Perceived stress was positively correlated with higher afternoon cortisol levels and greater symptom distress.

Conclusion: Moderate symptoms and symptom distress found in our sample indicate the need for interventions to address these outcomes in men treated for prostate cancer. Self-reported perceived stress can be used to assess the stress level and symptom distress in clinic setting.

Implications for Practice: Patients treated for prostate cancer with RP or RT should be assessed for symptoms and symptom distress and targeted for early symptom management interventions.

Author Affiliations: National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland (Dr Hsiao); and College of Nursing, University of Arizona, Tucson (Drs Insel, Merkle, and Moore).

This study was supported by the Beta Mu Chapter of Sigma Theta Tau International Honor Society of Nursing and the Young Investigator Award funds from Yuma Friends of Arizona Health Sciences Center.

The authors have no conflicts of interest to disclose.

Correspondence: Chao-Pin Hsiao, PhD, National Institute of Nursing Resources, National Institutes of Health, 10 Center Dr, CRC/2-1339, Bethesda, MD 20892-1506 (

Accepted for publication December 6, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.