Breast Cancer Research and Treatment

, Volume 158, Issue 1, pp 43–50 | Cite as

Aberrant nocturnal cortisol and disease progression in women with breast cancer

  • Jamie M. ZeitzerEmail author
  • Bita Nouriani
  • Michelle B. Rissling
  • George W. Sledge
  • Katherine A. Kaplan
  • Linn Aasly
  • Oxana Palesh
  • Booil Jo
  • Eric Neri
  • Firdaus S. Dhabhar
  • David Spiegel
Preclinical study


While a relationship between disruption of circadian rhythms and the progression of cancer has been hypothesized in field and epidemiologic studies, it has never been unequivocally demonstrated. We determined the circadian rhythm of cortisol and sleep in women with advanced breast cancer (ABC) under the conditions necessary to allow for the precise measurement of these variables. Women with ABC (n = 97) and age-matched controls (n = 24) took part in a 24-h intensive physiological monitoring study involving polysomnographic sleep measures and high-density plasma sampling. Sleep was scored using both standard clinical metrics and power spectral analysis. Three-harmonic regression analysis and functional data analysis were used to assess the 24-h and sleep-associated patterns of plasma cortisol, respectively. The circadian pattern of plasma cortisol as described by its timing, timing relative to sleep, or amplitude was indistinguishable between women with ABC and age-matched controls (p′s > 0.11, t-tests). There was, however, an aberrant spike of cortisol during the sleep of a subset of women, during which there was an eightfold increase in the amount of objectively measured wake time (p < 0.004, Wilcoxon Signed-Rank). This cortisol aberration was associated with cancer progression such that the larger the aberration, the shorter the disease-free interval (time from initial diagnosis to metastasis; r = −0.30, p = 0.004; linear regression). The same aberrant spike was present in a similar percent of women without ABC and associated with concomitant sleep disruption. A greater understanding of this sleep-related cortisol abnormality, possibly a vulnerability trait, is likely important in our understanding of individual variation in the progression of cancer.


Cortisol Breast cancer Survival Sleep Circadian 



This work was supported by the National Cancer Institute (R01CA118567) and the National Center for Research Resources (UL1RR025744) at the National Institutes of Health. We thank our research participants for their time, wisdom, and willingness to participate, and the Dr. Susan Love Research Foundation’s Love/Avon Army of Women Program for their assistance in recruitment. We also wish to thank the nursing staff of the Clinical Translational Research Unit for staffing the studies, Ms. Chung-Ping Liao and Mr. Ryan Fisicaro for conducting the cortisol assays, and Mr. Daniel East for scoring the sleep data. We wish to thank Dr. Youngmee Kim for suggesting valuable edits to the manuscript.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Jamie M. Zeitzer
    • 1
    • 2
    Email author
  • Bita Nouriani
    • 1
  • Michelle B. Rissling
    • 2
    • 4
  • George W. Sledge
    • 3
  • Katherine A. Kaplan
    • 1
  • Linn Aasly
    • 1
    • 5
  • Oxana Palesh
    • 1
  • Booil Jo
    • 1
  • Eric Neri
    • 1
  • Firdaus S. Dhabhar
    • 1
  • David Spiegel
    • 1
  1. 1.Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordUSA
  2. 2.Mental Illness Research Education and Clinical CenterVA Palo Alto Health Care SystemPalo AltoUSA
  3. 3.Department of Medicine/OncologyStanford UniversityStanfordUSA
  4. 4.Durham VA Medical CenterDurhamUSA
  5. 5.Columbia UniversityNew YorkUSA

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