Evidence map›Paper›PMID 39569439›Full record

SynthesisCancer medicine2024

Hypothalamic-Pituitary-Adrenal Axis Dysfunction in People With Cancer: A Systematic Review.

Natalie G Kanter, Sarah Cohen-Woods, David A Balfour, Morton G Burt, Alison L Waterman, Bogda Koczwara

Erratum issuedAbstract readSystematic Review
In one paragraph

Synthesis in Cancer medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 24 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
24citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

24 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. From traditional warming and tonifying to psychoneuroimmunology: theoretical reconstruction and clinical application of moxibustion for cancer-related fatigue.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Review
  3. Review
  4. Article
  5. Article
  6. Cancer treatment-related cognitive impairment.Neuro-oncology advances · 2026
    Review
  7. Article
  8. Review
  9. Article
  10. Joint nausea and fatigue profiles during chemotherapy identify patients with a higher symptom burden.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Article
  11. Global research trends and hotspots in breast cancer related fatigue: a bibliometric investigation.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026
    Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Physical Activity, Exerkines, and Their Role in Cancer Cachexia.International journal of molecular sciences · 2025
    Review
  17. Review
  18. Review
  19. Review
  20. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors.

Natalie G KanterCollege of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.ORCID https://orcid.org/0000-0003-1892-8491
Sarah Cohen-WoodsFlinders University Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, South Australia, Australia.ORCID https://orcid.org/0000-0003-2199-6129
David A BalfourCollege of Education, Psychology, and Social Work, Flinders University, Bedford Park, South Australia, Australia.ORCID https://orcid.org/0000-0002-5295-8806
Morton G BurtCollege of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.ORCID https://orcid.org/0000-0001-6468-7727
Alison L WatermanCollege of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.ORCID https://orcid.org/0000-0002-9576-2985
Bogda KoczwaraCollege of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.ORCID https://orcid.org/0000-0002-1201-1642

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeCancer can be a source of significant psychological and physical stress. Prolonged stressful stimuli can influence the stress response, mediated by the hypothalamic-pituitary-adrenal (HPA) axis. However, there is limited literature investigating HPA axis function in patients with cancer.

methodsA systematic literature review of case-control 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.

resultsSeventeen studies met eligibility criteria: nine unstimulated-cortisol 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 13 reporting increased baseline or hyperactive cortisol responses, and four-decreased baseline cortisol or blunted cortisol responses, two of which had patient groups with now known cortisol-suppressing 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-being and disturbed sleep. There was significant heterogeneity in methodologies across the studies.

conclusionHPA dysfunction was common in patients with cancer relative to cancer-free controls. The majority of studies in cancer reported an increased baseline cortisol and increased response to HPA stimulation. There is a need for well-powered 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.

Indexed as

HydrocortisoneHypothalamo-Hypophyseal SystemNeoplasmsPituitary-Adrenal SystemCase-Control StudiesFemaleHumansMaleStress, PsychologicalHydrocortisoneglucocorticoidsneoplasmphysiologicalpituitary–adrenal systemstresssystematic review

Identifiers

PMID39569439
PMCPMC11579619

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.