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