Abstract
Due to physical hindrance and time spent in hospital, a cancer diagnosis can lead to disturbance of personally important goals. Goal disturbance in cancer patients has been related to poorer psychological well-being. However, the relation with physiological measures is yet unknown. The purpose of the current study is to examine the impact of goal disturbance on cortisol as a measure of response to stress over time, and a possibly moderating role of a DNA genotype associated with HPA-axis functioning, Catechol-O-Methyl transferase (COMT). We examined the predictive value of goal disturbance on Cortisol Awakening Response (CAR) and Diurnal Cortisol Slope (DCS) over two periods: 1–7 and 7–18 months post-diagnosis, and the moderating role of COMT during these periods. Hierarchical regression analyses showed that goal disturbance 7 months post-diagnosis significantly predicted a steeper CAR a year later. During that period, the slow COMT variant moderated the relation, in that patients reporting high goal disturbance and had the Met/Met variant, had a more flattened CAR. No other significant effects were found. As steeper CARs have been related to adverse health outcomes, and COMT genotype may modify this risk, these results indicate that goal disturbance and genotype may be important factors to consider in maintaining better psychological and physical health in the already vulnerable population of cancer patients.
Highlights
The successful pursuit of personal goals is important for maintaining well-being [1], as goals provide a sense of purpose in life and motivate daily activities [2,3]
Worries and daily stressors, like goal disturbance after cancer diagnosis, have been linked to steeper Cortisol Awakening Responses (CAR, increase in cortisol between awakening and 30–45 minutes later) [12,13,14,15,16,17] and flattened Diurnal Cortisol Slopes (DCS, decrease in cortisol between 30–45 minutes after awakening and bedtime) [18,19,20,21,22], which have been related to lower levels of psychological as well as psychical well-being [20,23,24,25,26]
Fifteen patients were excluded because the time registration was filled out incompletely or was not returned with the samples, and one further patient was excluded as no cortisol was present in the returned samples, leaving suitable samples of 98 patients
Summary
The successful pursuit of personal goals is important for maintaining well-being [1], as goals provide a sense of purpose in life and motivate daily activities [2,3]. In one study in healthy people, it was found that hindrances in goal attainment led to increased levels of cortisol [8], providing a first indication that goal disturbance can be considered a stressor impacting physiological outcomes. Worries and daily stressors, like goal disturbance after cancer diagnosis, have been linked to steeper Cortisol Awakening Responses (CAR, increase in cortisol between awakening and 30–45 minutes later) [12,13,14,15,16,17] and flattened Diurnal Cortisol Slopes (DCS, decrease in cortisol between 30–45 minutes after awakening and bedtime) [18,19,20,21,22], which have been related to lower levels of psychological as well as psychical well-being [20,23,24,25,26]. We will investigate the longitudinal impact of goal disturbance due to cancer on cortisol levels
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