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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. 1 Hunter College of the City University of New York (CUNY), 2 The Graduate Center (CUNY), 3 Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience UCLA, 4 Pitzer College, Claremont University Consortium, 6 University 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 cortisol 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
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