Association between hair cortisol concentration and cancer-related outcomes in adult patients: A systematic review
In brief
Higher hair cortisol tracked with shorter survival after liver cancer treatment
In a review of six studies involving 6,683 adults, elevated hair cortisol was linked to shorter disease-free and overall survival after curative treatment for liver cancer. Findings on cancer incidence were inconclusive, and results varied across measurement methods; inconsistent methods and limited adjustment for confounders mean the link needs confirmation in stronger prospective studies.
- Journal
- Psychoneuroendocrinology (Q1)
- Published
- 21 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Federico Fortuna, Honoria Ocagli, Luiza Siqueira Lima, Francesca Suraci, Diego Gonzalez, Juan Jose Jamardo, et al.
- PMID
- 42784920
- DOI
- 10.1016/j.psyneuen.2026.108029
Why clinicians should know about it
- Picked for Biochemistry (medical) (paper of the day, 27 September 2026): Systematic review of hair cortisol as a metabolic biomarker
- Picked for Oncology and Radiation Oncology (top studies of the week, 27 September 2026): Systematic review of HCC as stress biomarker in cancer outcomes
- Picked for Psychiatry and Mental Health (top studies of the week, 27 September 2026): High-quality evidence in a top journal
- Picked for Epidemiology (top studies of the week, 27 September 2026): Systematic review of hair cortisol, not primary epidemiology
Abstract
BACKGROUND: Chronic stress, through sustained hypothalamic-pituitary-adrenal (HPA) axis activation, has been implicated in cancer progression. Hair cortisol concentration (HCC) offers a unique retrospective window into cumulative cortisol exposure, yet its relationship with cancer outcomes has never been systematically examined. OBJECTIVE: To critically appraise the evidence linking HCC to cancer-related outcomes in adults and to identify the methodological gaps that currently limit this emerging field. METHODS: Four databases (PubMed, Embase, Scopus, Web of Science) and two trial registries (ClinicalTrials.gov, WHO ICTRP) were searched from inception to March 2026. Adults with confirmed cancer and HCC measured by any validated method were eligible. Risk of bias was assessed using Cochrane RoB 2, the Newcastle-Ottawa Scale, and the JBI checklist according to study design. Narrative synthesis followed SWiM guidelines. PROSPERO registration: CRD420261328214. RESULTS: From 2313 initial records, six studies (two randomised trials, two cohorts, two cross-sectional) met the inclusion criteria, spanning seven countries with 6683 participants. Elevated HCC predicted shorter disease-free and overall survival following curative hepatocellular carcinoma treatment. Hair cortisone, but not cortisol, was associated with cancer incidence in a population-based cohort after adjustment for age and gender. Breast cancer survivors showed significantly higher HCC than matched controls. One intervention trial demonstrated a significant reduction in HCC following a psychosocial programme, while another found no effect. Reported HCC varied widely across studies, with LC-MS/MS-based measurements ranging from below 3 to approximately 60 pg/mg, while a single ELISA-based study reported a mean of 1751 pg/mg, a discrepancy largely driven by analytical platform differences. Methodological quality was variable, with confounder adjustment and missing biological data representing recurring concerns. CONCLUSIONS: Limited evidence suggests that elevated chronic cortisol exposure may be associated with adverse survival outcomes in patients with established malignancies, while findings regarding cancer incidence remain inconclusive. Analytical heterogeneity, limited confounder control, and the predominance of breast cancer studies constrain the strength of these conclusions. Standardised measurement protocols and prospective longitudinal designs are essential next steps.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.