Stress Assessment by Salivary Biomarkers in Patients with Lung Cancer Undergoing Chemotherapy


Background: It is important for medical staffs to understand the state of stress of patients with cancer. The authors investigated stress assessment in patients with lung cancer undergoing chemotherapy. Materials and Method: Salivary cortisol and α-amylase were measured as stress markers before and after chemotherapy in 10 patients. Emotional status was assessed using the Profile of Mood States (POMS) questionnaire, and Quality of Life (QOL) was assessed using the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire. Results: No significant differences were found between the before and after chemotherapy in salivary levels of cortisol or α-amylase, the POMS and QOL scores. The salivary cortisol levels correlated with the POMS subscales of anger-hostility, and confusion. A negative correlation was observed between the salivary cortisol level and the QOL full score. The FACT-L full score correlated with the POMS subscales of depression-dejection, fatigue, and confusion. Conclusions: Measurements of salivary stress markers are noninvasive and may be useful for assessing the stress state of the patients

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M. Kitajima, Y. Noto, U. Kudo, M. Urushizaka, T. Tomisawa, C. Itaki, K. Kawasaki, H. Yamabe, A. Hayashi and S. Takanashi, "Stress Assessment by Salivary Biomarkers in Patients with Lung Cancer Undergoing Chemotherapy," Journal of Cancer Therapy, Vol. 3 No. 2, 2012, pp. 127-131. doi: 10.4236/jct.2012.32017.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] H. Selye and C. Fortier, “Adaptive Reaction to Stress,” Psychosomatic Medicine, Vol. 12, 1950, pp. 149-157.
[2] H. Selye, “Stress and the General Adaptation Syndrome,” British Medical Journal, Vol. 1, 1950, pp. 1383-1392. doi:10.1136/bmj.1.4667.1383
[3] R. S. Lazarus and S. Folkman, “Stress, Appraisal, and Coping,” Springer Pub, New York, 1984.
[4] S. E. Sephton, R. M. Sapolsky, H. C. Kraemer and D. Spiegel, “Diurnal Cortisol Rhythm as a Predictor of Breast Cancer Survival,” Journal of the National Cancer Institute, Vol. 92, No. 12, 2000, pp. 994-1000. doi:10.1093/jnci/92.12.994
[5] D. M. McNair, M. Lorr and L. F. Droppleman, “Profile of Mood States,” Educational and Industrial Testing Service, San Diego, 1992.
[6] K. Yokoyama, S. Araki, J. Osuga, T. Karita, M. Kurokawa and K. Koda, “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 (In Japanese).
[7] S. Morita, K. Kobayashi, K. Eguchi, T. Matsumoto, M. Shibuya, Y. Yamaji, J. Sakamoto and Y. Ohashi, “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, B. Sarafian, E. Linn, A. Bonomi, M. Silberman, S. B. Yellen, P. Winicour, J. Brannon and F. David, “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] A. Yoshimura, K. Kobayashi, H. Fumimoto, Y. Fujiki, S. Eremenco and S. H. Kudoh, “Cross-Cultural Validation of an International Questionnaire, the General Measure of the Functional Assessment of Cancer Therapy Scale (FACT-G), for Japanese,” Quality of Life Research, Vol. 10, No. 8, 2001, pp. 701-709. doi:10.1023/A:1013851216181
[10] D. F. Cella, A. E. Bonomi, S. R. Lloyd, D. S. Tulsky, E. Kaplan and P. Bonomi, “Reliability and Validity of the Functional Assessment of Cancer Therapy—Lung (FACTL) 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. Chang, S. Eremenco, H. Kaneko and K. Kobayashi, “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] K. M. 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, K. Kurata and K. Hirota, “The Relationship between Salivary Biomarkers and State-Trait Anxiety Inventory Score under Mental Arithmetic Stress: A Pilot Study,” Anesthesia & Analgesia, Vol. 101, No. 6, 2005, pp. 1873-1876. doi:10.1213/01.ANE.0000184196.60838.8D
[16] D. Kajdaniuk, B. Marek, E. Swietochowska, N. Ciesielska-Kopacz and B. Buntner, “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
[17] M. H. Lasikiewicz, H. Hendrickx, D. Talbot and L. Dye, “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
[18] J. M. Turner-Cobb, S. E. Sephton, C. Koopman, J. BlakeMortimer, D. Spiegel, “Social Support and Salivary Cortisol in Women with Metastatic Breast Cancer,” Psychosomatic Medicine, Vol. 62, No. 3, 2000, pp. 337-345.

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