Table 2.

Neuroendocrine Alterations in Cancer Patients with Behavioral Co-Morbidities

Investigator	Cancer Type	Patient Sample	Neuroendocrine Parameter	Behavioral Co-Morbidity	Results
Evans et al. 198655	Mixed	47 females with cervical, endometrial and vaginal cancer of varying stages	DST	Major Depression	21% of patients were DST non-suppressors. 40% of patients with major depression were DST non-suppressors.
Sephton et al. 200086	Breast	104 women with metastatic disease	Diurnal salivary cortisol rhythm	Sleep	Flattened cortisol slope was associated with increased nocturnal awakenings and decreased survival.
Musselman et al. 200153	Mixed	21 male and female patients with pancreatic, breast and esophageal cancer	DST	Major Depression	Post dexamethasone plasma cortisol concentrations correlated with depression, but not with IL-6.
Capuron et al. 200310	Melanoma	20 male and female subjects, Stage III–IV	ACTH and cortisol response to IFN-alpha	Major Depression	Exaggerated ACTH and cortisol responses to the first injection of IFN-alpha were associated with the development of depression during IFN-alpha therapy.
Bower et al. 200576	Breast	29 female breast cancer survivors	Salivary cortisol samples collected upon awakening and at 1200, 1700, and 2200 h on two consecutive days	Fatigue	Flattened cortisol slope was found in patients with fatigue.
Bower et al. 2005;77 200778	Breast	27 female breast cancer survivors	Salivary cortisol samples collected at 15-minute intervals throughout a stressful public speaking and mental arithmetic task	Fatigue	Salivary cortisol responses to stress were blunted in fatigued patients versus controls. Blunted cortisol responses in fatigued patients were associated with increased LPS-stimulated IL-6 production.
Rich et al. 200579	Colorectal	80 male and female patients with metastatic disease	Serum cortisol obtained at 800 and 1600 h	WHO performance, Fatigue	Flattened cortisol rhythm was associated with increased TNF-alpha, IL-6 and TGF-alpha.
Jehn et al. 200654	Metastatic Cancer	114 male and female patients with metastatic (Stage 4) disease	Diurnal cortisol secretion	Major Depression	Decreased variance in diurnal cortisol secretion (i.e. flattened cortisol rhythm) was found in depressed patients compared to controls.

ACTH-adrenocorticotropin; DST-dexamethasone suppression test; IL-interleukin; h-hour; IFN-interferon; LPS-lipopolysaccharide; TGF-transforming growth factor; TNF-tumor necrosis factor.