Degree Name





Life Sciences

Defense Date


Publication Date


First Faculty Advisor

Dr. Arden M. Morris

First Faculty Reader

Dr. Stephen Piccolo

Honors Coordinator

Dr. Steven L. Peck


Colorectal, Surgery, Survey, Cortisol, Distress, Sarcopenia


Distress among cancer patients has been broadly accepted as an important indicator of patient well-being. However, questions remain such as what patient characteristics are associated with high distress and whether patient-reported distress is correlated with distress biomarkers. To answer these questions, we performed a survey study of 238 colorectal patients in which we assessed patient-reported distress, possible contributors to that distress, and patient anxiety and depression. We also abstracted demographic and clinical information from patient charts and collected measures for salivary cortisol and sarcopenia. We conducted bivariate statistical analyses between patient demographics, clinical factors, and psychosocial measures with our three outcome variables patient-reported distress, cortisol, and sarcopenia, and also performed pair-wise bivariate analyses between each of our outcome variables. We found that patient-reported distress is associated with gender, partnered status, and cancer type and that these effects vary with patient age, in some cases disproportionately affecting younger patients. We also show that cortisol only displays positive correlations with emotional problems, anxiety, and depression in young patient groups (15-49 yrs, 50-65 yrs) and that sarcopenia is non-associated with psychosocial measures. We found no significant associations between patient-reported distress, salivary cortisol, and sarcopenia.

Our results suggest that young, single patients experience high levels of distress compared to other patient groups, and that salivary cortisol is only effective as a distress biomarker in younger patients. We suggest that despite often being considered less biased, distress biomarkers are not more useful than patient-reported measures in helping clinicians understand distress in colorectal cancer patients.


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