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@ARTICLE{Schmidt:130503,
      author       = {M. Schmidt$^*$ and J. Semik$^*$ and N. Habermann$^*$ and J.
                      Wiskemann$^*$ and C. M. Ulrich$^*$ and K. Steindorf$^*$},
      title        = {{C}ancer-related fatigue shows a stable association with
                      diurnal cortisol dysregulation in breast cancer patients.},
      journal      = {Brain, behavior and immunity},
      volume       = {52},
      issn         = {0889-1591},
      address      = {Orlando, Fla. [u.a.]},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2017-05582},
      pages        = {98 - 105},
      year         = {2016},
      abstract     = {Fatigue is a major burden for breast cancer patients
                      undergoing adjuvant therapy. Yet, its pathophysiology is
                      still not well understood. Hypothesized mechanisms include
                      dysregulations in the hypothalamic-pituitary-adrenal (HPA)
                      axis, which may be reflected in alterations in the diurnal
                      cortisol patterns. However, studies on the association
                      between cortisol and fatigue during adjuvant cancer therapy
                      are rare. We therefore assessed salivary cortisol at
                      awakening, 0.5h post-awakening, noon, 5 pm and 10 pm/bedtime
                      in 265 breast cancer patients undergoing adjuvant therapy at
                      three timepoints. Cancer-related fatigue was assessed with
                      the Fatigue Assessment Questionnaire (FAQ) covering the
                      physical, affective, and cognitive fatigue dimensions.
                      Multiple linear regression analyses were performed
                      cross-sectionally at the three timepoints as well as
                      longitudinally considering changes in cortisol and fatigue
                      over time. The results showed that the physical dimension of
                      cancer-related fatigue was significantly associated with
                      increased evening cortisol levels and higher overall
                      cortisol secretion. These associations were independent of
                      depressive symptoms. Morning cortisol levels, the cortisol
                      awakening response and the diurnal slope were not
                      consistently associated with physical fatigue. Affective and
                      cognitive fatigue showed no clear association with any of
                      the cortisol parameters. In conclusion, the physical but not
                      the affective or cognitive dimension of fatigue seems
                      associated with cortisol dysregulations in breast cancer
                      patients undergoing adjuvant therapy, characterized by an
                      unaffected cortisol level in the morning but blunted decline
                      to the evening level. Research focusing on disturbances of
                      the cortisol rhythm and HPA dysregulations during and after
                      cancer treatment may open new strategies to reduce
                      cancer-related fatigue.},
      keywords     = {Hydrocortisone (NLM Chemicals)},
      cin          = {G111 / G210},
      ddc          = {610},
      cid          = {I:(DE-He78)G111-20160331 / I:(DE-He78)G210-20160331},
      pnm          = {317 - Translational cancer research (POF3-317)},
      pid          = {G:(DE-HGF)POF3-317},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:26456694},
      doi          = {10.1016/j.bbi.2015.10.005},
      url          = {https://inrepo02.dkfz.de/record/130503},
}