5 Background: Cancer symptom clusters such as co-occurring pain, fatigue, and sleep disturbance, are common and debilitating for patients with advanced disease. Stress-related neuorendocrine system alterations are thought to play a significant role in symptom co-occurrence. While studies have documented relationships between stress biomarkers and symptoms in persons with cancer, few have done so in the context of a specific symptom cluster or among persons receiving treatment for advanced disease. Objectives: This preliminary analysis describes biomarkers of neuroendocrine stress systems – salivary cortisol and salivary alpha amylase (sAA) – and their relationship with the pain, fatigue, sleep disturbance symptom cluster in cancer. Methods: We analyzed baseline data from 14 participants of a RCT of a cognitive-behavioral symptom cluster intervention. Participants were receiving chemotherapy for recurrent or metastatic cancer. The sample was largely female (93%), aged 50-74 years old (M=63.57), with lung (57%), breast (14%), GYN (22%) or prostate (7%) cancer. Participants reported symptom cluster severity and collected saliva over two days prior to a new chemotherapy cycle. Cortisol concentrations were determined by luminescence immunoassay and salivary alpha-amylase by enzyme kinetic reaction assay using standardized kits (Salimetrics, State College, PA). Results: Mean (SD) cortisol and sAA levels were within normal range and followed typical diurnal patterns (Table 1); although evening levels of cortisol appeared higher in this sample compared to those of healthy adults. Low to moderate observed correlations between symptom cluster severity and stress biomarkers (evening cortisol r = -.204; evening sAA r = .326) were not significant in this small sample. Conclusions: Elevated evening cortisol levels may suggest dysregulation of the stress response in this population. The ongoing study will further evaluate if alterations in neuroendocrine function contribute to the symptom cluster experience. Clinical trial information: NCT01954420. [Table: see text]