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Approach and Avoidance Coping: Diurnal Cortisol Rhythm in Prostate Cancer Survivors
Michael A. Hoyt, Ph.D.1, Amanda M. Marin-Chollom, M.A.2, Julienne E. Bower, Ph.D., Michael R. Irwin, MD, KaMala S. Thomas, Ph.D., Annette L. Stanton, Ph.D. 1Hunter College of the City University of New York (CUNY), 2The Graduate Center (CUNY), 3Cousins Center for Psychoneuroimmunology,
Semel Institute for Neuroscience UCLA, 4Pitzer College, Claremont University Consortium, 6University of California Los Angeles
BACKGROUND: Aberrant diurnal cortisol patterns have been linked to a number of physical and psychological outcomes in
cancer patients (Bower, Ganz, & Aziz, 2005), including disease progression and earlier mortality in women with breast cancer
(Sephton et al., 2000; Abercrombie et al., 2004). Limited research with breast cancer patients has suggested that diurnal
cortisol rhythm may be shaped by individual coping strategies (Giese-Davis et al., 2004). However, no study has examined
these associations in men with cancer.
METHODS: Men (N=67; M age=66.33, SD=9.66) treated for localized prostate cancer in the preceding two years were
enrolled in a study of “health-related quality of life.” Cancer-specific coping was assessed at study entry (T1) with a modified
version of the Brief COPE (Carver, 1997) and the Emotional Approach Coping Scales (Stanton et al., 2000). Composite
scores of approach and avoidance coping were computed. At T1 and again four months later (T2), participants provided
saliva samples (4 times per day over 3 days) for measurement of cortisol output.
RESULTS: Hierarchical linear modeling analyses were conducted to test for concurrent associations and relationships over
time. Approach coping was not associated with T1 (B = - .04, p = .63 or T2 (B = .05, p = .52) cortisol slopes. However, higher
levels of avoidance coping was associated with flatter cortisol slopes (i.e., higher cortisol levels at bedtime) both concurrently
(B = .34, p = .03) and over time (B = .30, p = .02). *Further analyses was run controlling for age and BMI and results were still statistically
significant (other biobehavioral variables were controlled by study design).
CONCLUSION: As expected, high levels of avoidance coping was
associated with flatter cortisol slopes at T1 and across
time. Cortisol rhythms may be one mechanism by which
coping affects health-related quality of life in prostate
cancer patients, particularly for avoidant-oriented coping
strategies. Although previous research with women with
cancer has demonstrated a relationship of cortisol and
approach coping, avoidance may be more salient in
men’s experience
FUTURE RESEARCH: More research is needed to examine these relationships
across the disease trajectory and to identify individual
factors that might condition the impact of avoidance on
stress responses.
Table 1. Sample Characteristics
N = 67
Mean Age 66.33 (SD=9.66)
Ethnicity
White, -Non-Hispanic
African American/Black
Latino/Hispanic
Other
84.8%
10.6%
3.0%
1.5%
Modal Income > $100,000
Education
High School/GED
Some College/Tech School
2-year College Degree
4-year College Degree
Some post-graduate
Advanced Degree
10.6.%
21.2%
9.1%
13.6%
12.1%
33.3%
Employment Status
Employed Full-time
Employed Part-time
Retired
Medical Leave/Disability
Unemployed/Homemaker
35.4%
10.8%
47.7%
3.0%
3.0%
Relationship Status
Single
Divorced/Separated/Widowed
Married/Remarried
Partnered
3.0%
7.5%
77.3%
12.1%
Salivary
co
rtis
ol
log
ng
/dL
Figure 1. Salivary cortisol levels as a function of the relationship between time of day and avoidance coping
CURRENT STUDY: The present studied examined how approach- versus avoidant-oriented coping strategies affect diurnal
cortisol rhythm in prostate cancer survivors.
0
0.5
1
1.5
2
2.5
Waking 30 min. Post Afternoon Bedtime
Low Avoidance
High Avoidance