Perceived Efficacy of Stress Management Skills, Emotional Distress, and Diurnal Cortisol in Women With Metastatic Breast Cancer

This study aimed to examine the associations among perceived efficacy in using stress management skills, emotional distress, and diurnal cortisol pattern in women diagnosed with metastatic breast cancer (N = 60, M-age = 58.95 +/- 1.49). The Brief Symptom Inventory and the Measure of Current Status were used to measure distress and perceived stress management skills efficacy (PSMS), respectively. Salivary cortisol levels were assessed at waking, 5 p.m. and bedtime on three consecutive days and averaged. Results indicated that patients with less perceived stress management skill efficacy have greater levels of distress and patients with greater distress reveal a poorly regulated hypothalamic pituitary adrenal (HPA) axis as reflected in a flatter cortisol diurnal slope. PSMS indices most strongly associated with less distress levels were Coping Confidence (e.g., cognitive reappraisal) and Relaxation. PSMS and depressive symptoms were significantly associated, and each one was significantly associated with diurnal cortisol slope. However, simple mediation analyses estimating the indirect effects of PSMS on diurnal cortisol slope through either distress or depression was not significant. These results provide preliminary support that identifying metastatic breast cancer patients with greater distress levels and offering training in stress management skills could improve psychological status and normalize physiological processes known to predict negative health outcomes.