Preliminary results of a study investigating potential biomarkers for chemotherapy-induced peripheral neuropathy (CIPN) suggest that reduced cortisol patterns may contribute to this adverse event in patients with cancer. These findings were published in Oncology Nursing Forum.

Researchers explored the role of hypothalamic-pituitary-adrenal (HPA) axis dysregulation in the pathophysiology of CIPN. One method for assessing HPA axis dysregulation is to measure salivary cortisol levels; therefore, the salivary cortisol patterns in cancer patients with CIPN were analyzed for this study.

Salivary cortisol data were collected from 13 participants of a pilot randomized, controlled trial designed to examine the feasibility of a yoga intervention for cancer survivors with chronic CIPN. As part of this secondary study, data were collected when the patients woke up, approximately 30 to 45 minutes after waking, and just before bedtime for 2 consecutive days. The samples were obtained with a swab and frozen, then sent to the laboratory for evaluation.

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Normally, adults experience a 50% increase in cortisol levels from the time they awake until approximately 30 to 34 minutes later, and their lowest cortisol levels occur around bedtime. But the study participants experienced a different pattern (an approximately 10% decrease and a flatter diurnal cortisol slope), which may be associated with worse mental and physical health outcomes.

“The preliminary results of this study suggest that cancer survivors with chronic CIPN pain demonstrated an attenuated cortisol awakening response and flatter diurnal cortisol slope at baseline, suggesting that HPA axis dysregulation may be a contributing pathophysiologic mechanism to chronic CIPN pain,” the researchers concluded, adding that future research could help shape interventions to target HPA axis dysregulation and improve the pain of chronic CIPN.  

The study was limited by large amounts of missing data associated with salivary cortisol collection at baseline. Due to transmission concerns related to the COVID-19 pandemic, collection was discontinued after samples were received from 13 of 44 participants.

However, the study does have some implications for nurses. “Nurse scientists may use these results to inform future research exploring stress-related biomarkers of chronic CIPN pain,” the researchers reported.

Disclosure: Multiple authors declared an affiliation with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Knoerl R, Giobbie-Hurder A, Berfield J, et al. Exploring daily salivary cortisol patterns as biomarkers of chronic chemotherapy-induced peripheral neuropathy pain. Oncol Nurs Forum. 2022;49(3):207-211. doi:10.1188/22.onf.207-211