Efficacy of Cancer Chemotherapy in Relation to Synchronization of Cortisol Rhythm, Immune Status and Psychospiritual Profile in Metastatic Non-small Cell Lung Cancer

Background: The prognosis of cancer and the efficacy of the various anticancer therapies depend not only on tumor characteristics, but also on the endocrine and immunestatusofpatients.Moreover,studieshaveshownthat the clinical course of the neoplastic disease is also influencedbythepsychospiritualstatusofpatients.Itisthus probable that the influence of psychospirituality on tumor growth may be mediated by the immunoneuroendocrine system, as demonstrated by the recent advances in psychoneuroendocrinological research. However, at present there are only few data on the possible link between the psychospiritual status and immunoendocrine functions of cancerpatients.Thisstudywascarriedouttoinvestigatethe relationships existing among the psychospiritual profile, cortisol rhythm and lymphocyte number before and after chemotherapy, and the efficacy of chemotherapy itself in advanced cancer patients. Patients and Methods: The study included 30 consecutive metastatic non-small cell lung cancer patients under chemotherapeutic treatment with cisplatin plus gemcitabine. The psychobiological investigations consisted of lymphocyte count, cortisol circadianrhythm,psychologicalprofileusingRorschachtest, andspiritualscore,asassessedbyaspecificclinicaltestfor spirituality. The control group consisted of 100 healthy volunteers. The patients who achieved a tumor regression, showed a significantly higher pre-treatment lymphocyte count and significantly lower alteration of the cortisol rhythm with respect to those who had no benefit from chemotherapy. Moreover, the lymphocyte mean number increased during chemotherapy in responder patients, whereasitprogressivelydiminishedinthosewhohaddisease progression.Lymphocytopeniaandalterationsofthecortisol rhythmpriortochemotherapywereassociatedwithalossof the psychosexual identity according the Rorschach test. Moreover, the mean spiritual score was lower in patients thanincontrols,althoughthedifferencewasnotsignificant. Finally,alowspiritualscorepriortotherapywasassociated with a higher frequency of lymphocytopenia and cortisol rhythm alteration, as well as with a lower efficacy of chemotherapy itself. Conclusion: This preliminary study would suggest that the psychospiritual status of cancer patientsmayinfluencetheefficacyofchemotherapythrough