{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T07:09:03Z","timestamp":1791356943034,"version":"4.3.1"},"reference-count":43,"publisher":"Wiley","issue":"22","license":[{"start":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T00:00:00Z","timestamp":1732147200000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Cancer can be a source of significant psychological and physical stress. Prolonged stressful stimuli can influence the stress response, mediated by the hypothalamic\u2013pituitary\u2013adrenal (HPA) axis. However, there is limited literature investigating HPA axis function in patients with cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic literature review of case\u2013control studies was conducted comparing individuals with and without cancer examining the HPA axis function. Databases (MEDLINE, PubMed, Scopus) were searched from inception to May 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen studies met eligibility criteria: nine unstimulated\u2010cortisol studies and eight reporting the effect of HPA stimulation or suppression. Sixteen studies reported altered levels of HPA function in cancer patients relative to controls, including 12 reporting increased baseline or hyperactive cortisol responses, and four\u2014decreased baseline cortisol or blunted cortisol responses, two of which had patient groups with now known cortisol\u2010suppressing treatments. HPA dysfunction was observed in patients of both sexes, diverse ages, stages of cancer and cancer treatments. Six papers reported on clinical outcomes with cases experiencing higher levels of fatigue, stress, poor memory, poor well\u2010being and disturbed sleep. There was significant heterogeneity in methodologies across the studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HPA dysfunction was common in patients with cancer relative to cancer\u2010free controls. The majority of studies in cancer reported an increased baseline cortisol and increased response to HPA stimulation. There is a need for well\u2010powered studies using standardised methodology examining the mechanisms of HPA dysregulation and their health outcomes, to enable the development of appropriate tools for the diagnosis and management of HPA dysfunction in cancer.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cam4.70366","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T04:29:47Z","timestamp":1732163387000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Hypothalamic\u2013Pituitary\u2013Adrenal Axis Dysfunction in People With Cancer: A Systematic Review"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1892-8491","authenticated-orcid":false,"given":"Natalie G.","family":"Kanter","sequence":"first","affiliation":[{"name":"College of Medicine and Public Health Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2199-6129","authenticated-orcid":false,"given":"Sarah","family":"Cohen\u2010Woods","sequence":"additional","affiliation":[{"name":"Flinders University Institute for Mental Health and Wellbeing Flinders University  Bedford Park South Australia Australia"},{"name":"College of Education, Psychology, and Social Work Flinders University  Bedford Park South Australia Australia"},{"name":"Flinders Centre for Innovation in Cancer College of Medicine and Public Health, Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5295-8806","authenticated-orcid":false,"given":"David","family":"Balfour","sequence":"additional","affiliation":[{"name":"College of Education, Psychology, and Social Work Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6468-7727","authenticated-orcid":false,"given":"Morton G.","family":"Burt","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health Flinders University  Bedford Park South Australia Australia"},{"name":"Southern Adelaide Diabetes and Endocrine Services Flinders Medical Centre  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9576-2985","authenticated-orcid":false,"given":"Alison L.","family":"Waterman","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health Flinders University  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1201-1642","authenticated-orcid":false,"given":"Bogda","family":"Koczwara","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health Flinders University  Bedford Park South Australia Australia"},{"name":"Department of Medical Oncology Flinders Medical Centre  Bedford Park South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.18043\/ncm.75.4.283"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrn2914"},{"key":"e_1_2_11_4_1","volume-title":"Endotext [Internet]","author":"Tsigos C.","year":"2020"},{"key":"e_1_2_11_5_1","volume-title":"StatPearls [Internet]","author":"Thau L.","year":"2024"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.31887\/DCNS.2006.8.4\/ssmith"},{"issue":"2","key":"e_1_2_11_7_1","first-page":"1","article-title":"Chronic Stress and the HPA Axis","volume":"9","author":"Guilliams T. 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