Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Psychological and Brain Sciences

Degree Program

Clinical Psychology, PhD

Committee Chair

Sephton, Sandra E.

Committee Co-Chair (if applicable)

Salmon, Paul

Committee Member

Salmon, Paul

Committee Member

Stetson, Barbara

Committee Member

Newton, Tamara

Committee Member

Cash, Elizabeth

Author's Keywords

breast cancer; distress; circadian; endocrine; immune; survival


Women with breast cancer experience significant stress related to diagnosis and treatment, which may negatively affect physiology (e.g., circadian, endocrine, and immune) and contribute to cancer progression. Demographic (e.g., ethnic minority) and neighborhood factors can contribute to cancer-related stress. African American women with breast cancer experience more adverse disease pathology and earlier mortality; however, factors that explain these disparities rarely have been explored. It is hypothesized that psychosocial stressors (i.e., ethnicity, neighborhood stress, and cancerrelated stress) will be related to one another. Associations of psychosocial stress with physiological disruption are posited with regard to circadian, endocrine, and immune function. It is also hypothesized that psychosocial stress and physiological disruption will predict earlier cancer recurrence/mortality. Presurgical breast cancer patients (N=57) reported on demographics and cancerrelated stress and provided three-day home-based collection of rest/activity rhythms and salivary cortisol. Neighborhood stress data were obtained via the 2010 Census. Immune parameters were assessed in serum samples. Progression-free survival status was obtained at a median of seven years post-enrollment. Bivariate correlations examined relationships between psychosocial stressors. Hierarchical linear regressions adjusted for age, cancer stage, and income in tests of associations between psychosocial stress and physiological disruption. Cox proportional hazards analyses tested the prognostic value of psychosocial stress and physiological disruption on progression-free survival from initial diagnosis and study entry. African Americans had higher neighborhood stress compared to non-Hispanic White patients. Patients with greater neighborhood stress had greater overall cortisol secretion (ΔR2 = .246, p = .001). Patients reporting greater cancer-related stress had accentuated diurnal cortisol rhythms (ΔR2 = .084, p = .047). Exploratory post hoc analyses revealed this finding was likely driven by avoidance of cancer-related thoughts. Psychosocial stress was not significantly related to circadian or immune disruption, nor was psychosocial stress or physiological disruption predictive of progression-free survival. Improved resources within disadvantaged neighborhoods may help counter the effects of neighborhood stress on cortisol disruption by reducing stress and improving health outcomes. Interestingly, during the acutely stressful presurgical period, avoidance appears to serve as an adaptive coping strategy. Therefore, the presurgical period may be the opportune time to introduce psychosocial interventions to combat challenges throughout one’s cancer journey.