Early Cortisol and Inflammatory Responses to Parental Cancer and Their Impact on Functional Impairment in Youth

Purpose: Chronic stress is associated with increased risk for maladaptive psychological responses during childhood, adolescence, and young adulthood. Adults exposed to chronic stress during childhood exhibit dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity and inflammation. There are no studies examining the impact of stress on biological stress responses and functional impairment in adolescents and young adults early after the onset of a stressor. Methods: The sample consisted of 59 offspring, aged 11–25 years, 33 of parents diagnosed with cancer and 26 controls from families with no cancer or severe chronic illness in parents or siblings. Cancer patients and their families were recruited within an average of 62 days (SD = 35.9) and followed at 6 and 9 months later. Functional impairment was assessed and hair cortisol concentrations (HCC), salivary cortisol, and inflammatory markers were measured. Mixed regression analyses were conducted. Results: The stress group showed higher functional impairment (β = −5.5, 95% CI (−10.4, −0.06), p = 0.03, d= −0.40) and HCC (β = 10.5, 95% CI (−5.5, −0.50), p < 0.001, d = 1.43). However, HCC were reduced over time in the stress group (β= −0.3, 95% CI (−0.04, −0.01), p < 0.001, d = −1.08). Higher total cortisol output was associated with increased functional impairment over time (β = −3.0, 95% CI (−5.5, −0.5), p = 0.02, d = −0.60). Conclusions: Parental cancer is associated with early increase in cortisol, which was associated with increased functional impairment in offspring. Clinicians need to assess and monitor psychiatric symptoms and functioning in these offspring early on following parental cancer diagnosis.