Cortisol, Immune Status and Patients’ Coping in Primary Breast Cancer

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Abstract
Background: The coping mechanisms of cancer patients have received increasing scientific interest but have rarely been studied in patients, before their malignant disease is discovered. Negative influence on cellular immune parameters by stress, mourning, and depression could be verified. In a feedback circle of stress-induced immunosuppression, an important role is played by hormones of the hypothalamus-pituitary gland-adrenal cortex axis (HPA axis). Given in therapeutical doses, these hormones predominantly exert immunosuppressive effects in the periphery. Whether or not hormonal differences exist in depending on the character of the tumor, i.e. malignancy or benignancy, and diverse coping mechanisms, is still an open question. Patients and Methods: In order to evaluate the interaction of coping mechanisms, HPA axis and immune functions, we examined 32 patients with breast carcinoma, 20 patients with benign breast tumors, and 15 healthy controls with respect to: i) basic morning cortisol levels and cortisol after stimulation with human cortisol-releasing hormone (hCRH), ii) immunologic parameters (lymphocytes and T-lymphocyte sub-populations, immune globulines, neopterin and c-reactive protein (CRP) and iii) psychosocial data (Mental Adjustment to Cancer Scale (MAC Scale)). Results: There were significant correlations between the character of the tumor and the number of T helper cells as well as hCRH-stimulated cortisol. Multiple correlations were observed between immunological parameters, cortisol values and psychosocial data. Conclusion: Patients with breast cancer showed significantly elevated hCRH-stimulated cortisol values together with simultaneously significantly lowered T helper cell numbers so that a stress-induced immunosuppression could be presumed. Some experiments suggest stress as a factor influencing tumor growth, but stress seems to have suppressive effects only if possibilities of habituation and control are reduced. In contrast to this, stress can have tumor-protective effects if coping mechanisms are sufficient. Future research is needed to investigate the role of disease management in general and the effects of therapeutical intervention on cancer, relapse, and overall prognosis.

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