Salivary Biomarkers May Be Useful to Assess Stress State in Patients with Lung Cancer Undergoing Chemotherapy

Maiko Kitajima, Yuka Noto, Umi Kudo, Mayumi Urushizaka, Toshiko Tomisawa, Chieko Itaki, Kumiko Kawasaki, Hideaki Yamabe, Akihito Hayashi, Shingo Takanashi

.

DOI: 10.4236/ijcm.2011.25095                

Abstract

Objective: As it is important for medical staff to understand the stress state of patients with cancer, this study investigated the stress state in patients with lung cancer undergoing chemotherapy using salivary biomarkers and questionnaires. Materials and Methods: The subjects included 19 men and 9 women, with a mean age of 66.1 ± 7.1 years who received chemotherapy for lung cancer. Salivary samples of the participants were collected before and the 7 day after chemotherapy. Simultaneously, they completed the POMS (profile of mood states) and QOL (quality of life) questionnaires. The salivary cortisol and secretory IgA as stress markers were measured by enzyme immunoassay. Results: The salivary secretory IgA level was significantly higher at the 7th day after chemotherapy than before chemotherapy (p < 0.05), although the salivary cortisol level did not change. The tension-anxiety score, which is one of POMS subclasses, and total mood disturbance score were lower at day 7 of chemotherapy than before chemotherapy (p < 0.05), although no correlations were observed between POMS scores and salivary markers. However, a negative correlation was observed between the salivary cortisol level and the QOL full score (r= -0.411, p < 0.05). Conclusion: Measurement of salivary stress markers is noninvasive and may be useful for assessing the stress state of the patients.

Keywords

Lung Cancer, Chemotherapy, Secretory-IgA, Saliva, Stress Marker

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Center for Cancer Control and Information Services, National Cancer Center, Japan, “Age-Specific Mortality Rate -Lung,” 2009. http://ganjoho.jp/pro/statistics/gdball.html? 1%2%1
[2]	H. Selye and C. Fortier, “Adaptive Reaction to Stress,” Psychosomatic Medicine, Vol. 12, No. 3, 1950, pp. 149- 157.
[3]	H. Selye, “Stress and the General Adaptation Syndrome,” British Medical Journal, Vol. 1, 1950, pp. 383-392. doi:10.1136/bmj.1.4667.1383
[4]	R. S. Lazarus and S. Folkman, “Stress, Appraisal, and Coping,” Springer Publishing, New York, 1984.
[5]	D. M. McNair, M. Lorr, L. F. Droppleman, et al., “Profile of Mood States,” Educational and Industrial Testing Service, San Diego, 1992.
[6]	K. Yokoyama, S. Araki, N. Kawakami, et al., “Production of the Japanese Edition of Profile of Mood States (POMS): Assessment of Reliability and Validity,” Japanese Journal of Public Health, Vol. 37, 1990, pp. 913- 918.
[7]	S. Morita, K. Kobayashi, K. Eguchi, et al., “Influence of Clinical Parameters on Quality of Life during Chemotherapy in Patients with Advanced Non-Small Cell Lung Cancer: Application of a General Linear Model,” Japanese Journal of Clinical Oncology, Vol. 33, No. 9, 2003, pp. 470-476. doi:10.1093/jjco/hyg083
[8]	D. F. Cella, D. S. Tulsky, G. Gray, et al., “The Functional Assessment of Cancer Therapy Scale: Development and Validation of the General Measure,” Journal of Clinical Oncology, Vol. 11, No. 3, 1993, pp. 570-579.
[9]	H. Fumimoto, K. Kobayashi, C. H. Chang, et al., “Cross- cultural Validation of an International Questionnaire, the General Measure of the Functional Assessment of Cancer Therapy Scale (FACT-G),” Quality of Life Research, Vol. 10, 2001, pp. 701-709. doi:10.1023/A:1013851216181
[10]	D. F. Cella, A. E. Bonomi, S. R. Lloyd, et al., “Reliability and Validity of the Functional Assessment of Cancer Therapy—Lung (FACT-L) Quality of Life Instrument,” Lung Cancer, Vol. 12, No. 3, 1995, pp. 199-220. doi:10.1016/0169-5002(95)00450-F
[11]	E. Saitoh, Y. Yokomizo, C. H. Cang, et al., “Cross-Cultural Validation of the Japanese Version of the Lung Cancer Subscale on the Functional Assessment of Cancer Therapy-Lung,” Journal of Nippon Medical School, Vol. 74, No. 6, 2007, pp. 402-408. doi:10.1272/jnms.74.402
[12]	M. Kenneth and Hargreaves, “Neuroendocrine Markers of Stress,” Anesthesia Progress, Vol. 37, 1990, pp. 99-105.
[13]	M. Biondi and A. Picardi, “Psychological Stress and Neuroendocrine Function in Humans: The Last Two Decades of Research,” Psychotherapy and Psychosomatics, Vol. 68, No. 3, 1999, pp. 114-150. doi:10.1159/000012323
[14]	C. Kirschbaum and D. H. Hellhammer, “Salivary Cortisol in Psychoneuroendocrine Research: Recent Developments and Applications,” Psychoneuroendocrinology, Vol. 19, No. 4, 1994, pp. 313-333. doi:10.1016/0306-4530(94)90013-2
[15]	Y. Noto, T. Sato, M. Kudo, et al., “The Relationship between Salivary Biomarkers and State-Trait Anxiety Inventory Score under Mental Arithmetic Stress: A Pilot Study,” Anesthesia & Analgesia, Vol. 101, 2005, pp. 1873-1876. doi:10.1213/01.ANE.0000184196.60838.8D
[16]	D. L. Delacroix and J. P. Vaerman, “Function of the human Liver in IgA Homeostasis in Plasma,” Annals of the New York Academy of Sciences, Vol. 409, No. 1, 1976, pp. 383-401. doi:10.1111/j.1749-6632.1983.tb26884.x
[17]	H. Kubagawa, L. F. Bertoli, J. C. Barton, et al., “Analysis of Paraprotein Transport into the Saliva by Using Anti-Idiotype Antibodies,” Journal of Immunology, Vol. 138, 1987, p. 435.
[18]	S. Tsujita and K. Morimoto, “Secretory IgA in Saliva Can Be Useful Stress Marker,” Environmental Health and Preventive Medicine, Vol. 4, No. 1, 1999, pp. 1-8. doi:10.1007/BF02931243
[19]	N. M. Graham, R. C. Bartholomeusz, N. Taboonpong, et al., “Dose Anxiety Reduce the Rate of Secretory IgA in Saliva?” Medical Journal of Australia, Vol. 148, No. 3, 1988, pp. 131-133.
[20]	S. L. McDowell, R. A. Hughes, R. J. Hudhes, et al., “The Effect of Exercise Training on Salivary Immunoglobulin A and Cortisol Responses to Maximal Exercise,” International Journal of Sports Medicine, Vol. 13, No. 8, 1992, pp. 577-580. doi:10.1055/s-2007-1024568
[21]	D. Kajdaniuk, B. Marek, E. Swietochowska, et al., “Is Positive Correlation between Cortisol and Met-Enkephalin Concentration in Blood of Women with Breast Cancer a Reaction to Stress before Chemotherapy Administration?” Pathophysiology, Vol. 7, No. 1, 2000, pp. 47-51. doi:10.1016/S0928-4680(00)00028-6
[22]	A. Montazeri, C. R. Gillis and J. McEwen, “Quality of life in Patients with Lung Cancer: A Review of Literature from 1970 to 1995,” Chest, Vol. 113, No. 2, 1998, pp. 467-481. doi:10.1378/chest.113.2.467
[23]	N. Lasikiewicza, H. Hendrickxb, D. Talbot, et al., “Exploration of Basal Diurnal Salivary Cortisol Profiles in Middle-Aged Adults: Associations with Sleep Quality and Metabolic Parameters,” Psychoneuroendocrinology, Vol. 33, No. 2, 2008, pp. 143-151. doi:10.1016/j.psyneuen.2007.10.013
[24]	J. M. Turner-Cobb, S. E. Sephton, C. Koopman, et al., “Social Support and Salivary Cortisol in Women with Metastatic Breast Cancer,” Psychosomatic Medicine, Vol. 62, 2000, pp. 337-345.