Positive Psychological Adaptation to Cancer and Evidence in Stress-Associated Neuroendocrine Function

Ashley Wang, Ph.D.


Post-Doctoral Researcher, Department of Psychology, Hunter College, City University of New York.

Adjunct Assistant Professor, Department of Psychology, Hunter College, City University of New York.



Background.  Cancer diagnosis and treatment entail a series of stressors. Depression and anxiety are common among people diagnosed with cancer. The prevalence of depressive disorders after cancer diagnosis is two to three times higher than those of the general population. It is plausible that poor psychological adaptation to cancer goes hand-in-hand with biobehavioral alterations (i.e., Hypothalamic pituitary adrenal [HPA] axis dysregulation, inflammation and decreased immune functions, and eventually induces change in tumor growth factors that predicts survival and cancer recurrence). Many investigators have evaluated the effects of cognitive-behavioural and social factors on psychological adaptation to cancer. Psychological interventions either aim at alleviating distress or facilitating positive adaptation. The latter is termed ‘benefit finding (BF)’ and encompasses positive changes in a range of domains, including interpersonal relationships, self-strength, and priorities and goals. In Antoni et al. (2001)’s study, women with early-stage breast cancer who participated in a 10-week cognitive–behavioural stress management intervention reported increases in finding benefit from the cancer experience compared to the comparison group women. We wondered if these positive changes might result in improved physical health. If so, how might positive psychological changes (i.e., BF) result in improved physical health?


Method.  A sample of 66 men treated for localized prostate cancer within the prior two years completed questionnaires and collected salivary cortisol three times per day over three consecutive days. Hierarchical linear modeling was used for estimating diurnal cortisol slope and area under the curve (AUCg).


Result.  BF was significantly associated with diurnal cortisol slope, controlling for body mass index and age (b = -.12, p = .03), such that greater BF was associated with steeper slope. Subsequent analyses revealed that positive affect (PA) mediated the effect of BF on cortisol slope (Monte Carlo estimation 95% CI = -0.087, -0.001). The pathway by which BF influences cortisol slope is through its influence on PA.


Conclusion. Deriving more benefit from one’s experience with cancer is associated with a healthier diurnal cortisol rhythm. The effect of BF on physiological processes underscores the health relevant value of BF in prostate cancer survivors. In line with a handful of studies shown that greater BF is correlated with lower serum cortisol and increased lymphocyte proliferation in women with breast cancer (Cruess et al., 2000; McGregor et al., 2004), the literature offers a hint that experiencing benefits and growth may have beneficial physical effects. While we looked at proximal measure of physical health, stress-associated neuroendocrine regulation, the next step will be looking at whether such psychological adaptation to cancer could exacerbate cellular immune function and pro-inflammatory signaling, and, in turn, tumor progression. In sum, positive stress response renders the individual more resistant to future stressors. “Enhanced Allostasis” is one way BF exhibits adaptive physical responses to subsequent stressors. Resistance to future stressors could then lead to improved biological outcomes. To facilitate BF, intervention can help patients cognitively modify outlook, stress appraisals and making meaning out of negative experience.