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The cortisol level, depression anxiety stress score, and quality of life in patient with advance stage cervical cancer after two years of psychorative intervention

  • Soetrisno Soetrisno ,
  • Erindra Budi Cahyanto ,
  • Sri Mulyani ,
  • Angesti Nugraheni ,
  • Hafi Nurinasari ,
  • Rubin Enhui Tjiang ,


Background: Cervical cancer is the second most cancer in women after breast cancer. Emotional stress is the most common comorbid attacking women with advanced-stage cervical cancer, where 13- 40% are depressed which can increase mortality by 39%. Management of cervical cancer has so far focused on standard chemoradiation treatment, but has paid less attention to other aspects such as cognitive, psychological, spiritual and physical. The study aims to determine cortisol levels, Depression Anxiety Stress (DAS) score and quality of life for patients with advanced-stage cervical cancer after two years of psychocurative intervention

Methods: The pretest-posttest group design experimental study, continued previous studies, 30 subjects with advanced-stage cervical cancer patients, divided into 15 subjects received standard and psychocurative treatments, the other 15 as controls only received standard therapy. Psychocurative is done independently three times a week for two years based on psychocurative smart books. Home visits are conducted once per week to monitor, motivate the subject to do the psychocurative independently properly and discipline. Cortisol levels, DAS scores and quality of life were measured before and after treatment, the data were analysed by paired t-tests in the SPSS 25 program.

Results: One control group subject died before the study was completed. Before and after psychocurative, cortisol levels in the treatment group were 12.29 ± 4.36 and 6.71 ± 3.88 with p<0.05. The Depressive scores were 14.13 ± 3.02 and 8.46 ± 3.07 with p<0.05. The Anxiety scores 12.13 ± 1.64 and 6.73 ± 2.40 with p<0.05. The Stress scores were 14.40 ± 2.64 and 7.27 ± 2.81 with p<0.05. The quality of life score of the physical domain were 55.00 ± 6.54 and 62.67 ± 8.63 with p <0.05. The Psychical domain was 57.00 ± 9.41 and 65.66 ± 8.42 with p <0.05. The Social domain was 33.67 ± 9.15 and 41.67 ± 10.29 with p <0.05. The Environmental domain was 63.00 ± 1.93 and 69.33 ± 7.76 with p <0.05

Conclusions: Psychocurative decreases serum cortisol levels, decreases depression, anxiety, and stress scores and improves the quality of life of the physical, psychological, social and environmental domains.


  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015;65(2):87–108. doi: 10.3322/caac.21262
  2. Indonesian Ministry of Health RI. Current situation on cancer disease. Indonesian daily health magazine. Indonesian Ministry of Health: Jakarta; 2015. Available from:
  3. Satin J.R, Linden W, Phillips M.J. Depression as a predictor of disease progression and mortality in cancer patients: a meta analysis. Cancer. 2009;15;115(22):5349 61. doi: 10.1002/cncr.24561.
  4. Pinquart M and Duberstein PR. Depression and cancer mortality: a meta analysis. Psychol Med. 2010;40(11):1797 810. doi: 10.1017/S0033291709992285.
  5. Vodermaier A, Linden W, Siu C. Screening for Emotional Distress in Cancer Patients: A Systematic Review of Assessment Instruments. Psychooncology. 2014;23(2):121–130. doi: 10.1002/pon.3409
  6. Nayak MG, George A, Vidyasagar MS, Mathew S, Nayak S, et al. Quality of Life among Cancer Patients. Indian J Palliat Care. 2017;23(4):445–50. doi: 10.4103/IJPC.IJPC_82_17
  7. Shyu IL, Hu LY, Chen YJ, Wang PH, Huang BS. Risk factors for developing depression in women with cervical cancer: a nationwide population-based study in Taiwan. Int J Womens Health. 2019;11:135–141. doi: 10.2147/IJWH.S193003
  8. Soetrisno. Expression of heatstock protein 60, 70 and cortisol level in labour with psychocurative intervention [Medical Desertation]. Surabaya: Universitas Airlangga; 2015.
  9. Morey JN, Boggero IA, Scott AB, Segerstrom SC. Current Directions in Stress and Human Immune Function. Curr Opin Psychol. 2015;5:13–17. doi: 10.1016/j.copsyc.2015.03.007
  10. Graeff F, Junior ZH. 2010. The hypothalamicpituitary - adrenal axis in anxiety and panic. Psychology & Neuroscience. 2010;3(1):3-8. doi: 10.3922/j.psns.2010.1.002
  11. Hsiao FH, Jow GM, Kuo WH, Chang KJ, Liu YF, et al. The effects of psychotherapy on psychological well-being and diurnal cortisol patterns in breast cancer survivors. Psychother Psychosom. 2012;81(3):173-82. doi: 10.1159/000329178.
  12. Lovibond PF: Overview of the DASS and Its Uses; 2015. Available from: http://www2.psy.unsw.
  13. Feder K, Michaud DS, Keith SE, Voicescu SA, Marro L, et al. An assessment of quality of life using the WHOQOL-BREF among participants living in the vicinity of wind turbines. Environmental Research. 2015;142:227–38 doi: 10.1016/j.envres.2015.06.043
  14. Soetrisno, Mulyani S, Nugraheni A, Nurinasari H, Cahyanto EB. The Influence of psychocurative on cortisol levels, anxiety scores, and quality of life in advanced stage cervical cancer patients. Fol Med Indones. 2019;55(3):202-05.
  15. Aydogan U, Doganer YC, Komurcu S, et al. Coping Attitudes of Cancer Patients and Their Caregivers and Quality of Life of Caregivers. Indian journal of palliative care. Wolters Kluwer - Medknow Publications. 2016;22(2):150 – 6.
  16. Bermudez A, Bhatla N, Leung E. FIGO Cancer Report. Cancer of the Cervix Uteri. Int J of Gynecol Obstet. 2015;131:588-95.
  17. Linden W, Vodermaier A, Mackenzie R, Greig D. Anxiety and depression after cancer diagnosis: Prevalence rates by cancer type, gender, and age. Journal of Affective Disorders. 2012;141(2-3):343–51. doi: 10.1016/j.jad.2012.03.025.
  18. Guo Z, Tang H, Li H, et al. The benefits of psychosocial interventions for cancer patients undergoing radiotherapy. Health Qual Life Outcomes. 2013;11:121. doi:10.1186/1477-7525-11-83
  19. Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12:160–174. doi:10.1016/S1470-2045(11)70150-4
  20. Lee DY, Kim E, Choi MH. Technical and clinical aspects of cortisol as a biochemical marker of chronic stress. Biochemist Mol Biol Rep. 2015;48(4):209-216
  21. Division of Mental Health and Prevention of Substance Abuse. Programme On Mental Health. WHOQOL User Manual. WORLD HEALTH ORGANIZATION; 2012. Availale from:
  22. Smith MM, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncol. 2010 Dec; 6(12): 1863–1881. doi: 10.2217/fon.10.142

How to Cite

Soetrisno, S., Cahyanto, E. B., Mulyani, S., Nugraheni, A., Nurinasari, H., & Tjiang, R. E. (2020). The cortisol level, depression anxiety stress score, and quality of life in patient with advance stage cervical cancer after two years of psychorative intervention. Bali Medical Journal, 9(1), 6–12.




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Soetrisno Soetrisno
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Erindra Budi Cahyanto
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Sri Mulyani
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Angesti Nugraheni
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Hafi Nurinasari
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Rubin Enhui Tjiang
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