Cancer survivors' responses to daily stressors: implications for quality of life

OBJECTIVE: This study examined cancer survivors' experience of and responses to challenges and stressors associated with everyday living. The impact of daily stressors on quality of life concerns and cortisol patterns was also investigated. METHOD: Participants included 111 cancer survivors who participated in a national telephone diary study of daily experiences (National Study of Daily Experiences). Their responses were compared with those of 111 sociodemographically matched participants with no cancer history using a multilevel modeling approach. Over an 8-day period, participants completed a daily inventory of the occurrence and impact of stressful events, affect, and physical symptoms. Salivary cortisol was sampled four times per day, and indices of awakening response (cortisol awakening response), diurnal slope, and overall output (area under the curve) were examined. RESULTS: Cancer survivors experienced similar numbers and types of stressful events as the comparison group. Although appraisals were largely comparable, cancer survivors showed a modest tendency to perceive stressors as more severe and disruptive, particularly those involving interpersonal tensions. The occurrence of stressors was associated with increased negative affect, decreased positive affect, and increased physical symptoms, but little change in cortisol. Relative to the comparison group, cancer survivors showed less pronounced changes in positive affect and cortisol output when stressors occurred, but a greater increase in negative affect in response to interpersonal conflicts. CONCLUSION: Findings indicate that cancer survivors show a resilient ability to respond to day-to-day stressors and challenges. However, daily stressors can have a significant impact on survivors' mood and physical symptoms and therefore may be an important intervention target.