Anxiety levels parallel changes in inflammation over time in ovarian cancer patients

Abstract

Although extensive research has documented a relationship between depression and inflammation, links between anxiety and inflammation are less well-characterized. Among ovarian cancer patients, who generally have a poor prognosis, 29%-38% have signif-icant anxiety at diagnosis. However, little is known about the relationship of anxiety with inflammation, which often supports tumor progression in ovarian cancer. To address this issue, we examined changes in anxiety over time in ovarian cancer patients following primary treatment, and associations of anxiety with inflammation and inflammatory control. Participants (n = 373) completed questionnaires assessing anxiety symptoms (POMS-SF anxiety sub-scale), and had blood draws pre-surgery, following chemotherapy (6-months), and 12-months post-diagnosis. Linear-mixed models assessed associations between changes in anxiety and changes in IL-6 and nocturnal cortisol over time, with age and cancer stage as covariates. Self-reported anxiety decreased significantly from pre-surgery (M = 9.51, S.D. = 5.65) to 6 months (M = 4.58, S.D. = 4.70, p < 0.001) and was stable from 6 months to 1 year (n.s.). Decreases in anxiety mirrored decreases in IL-6 (beta = 0.013, p = 0.006) and nocturnal cortisol (beta = 0.092, p = 0.04) over time. These findings do not address directionality or possible causality between anxiety and inflammation. However, as elevations in both IL-6 and nocturnal cortisol have been related to shorter survival in ovarian cancer, patients with increasing anxiety during the first year following diagnosis may be at risk for more rapid disease progression. Further examination of mechanisms underlying these results is warranted.