Association between hair cortisol concentration and cancer-related outcomes in adult patients: A systematic review.

In 30 seconds

This systematic review assessed whether hair cortisol concentration (HCC), a marker of cumulative cortisol exposure, is associated with cancer outcomes in adults with confirmed cancer. Six studies—two randomised trials, two cohorts and two cross-sectional studies—covered 6,683 participants across seven countries. Elevated HCC was associated with shorter disease-free and overall survival after curative treatment for hepatocellular carcinoma. Evidence on cancer incidence was inconclusive: hair cortisone, but not cortisol, was associated with incidence in one population-based cohort. Measurement methods and study quality varied substantially.

Key findings

• Elevated HCC predicted shorter disease-free and overall survival after curative hepatocellular carcinoma treatment.
• In a population-based cohort, hair cortisone, but not cortisol, was associated with cancer incidence after adjustment for age and gender.
• Breast cancer survivors had significantly higher HCC than matched controls.
• One psychosocial intervention trial reduced HCC significantly, while another found no effect.

Why it matters

The review suggests that cumulative cortisol exposure may relate to survival in people with established cancer, but the evidence is too limited and heterogeneous to establish a reliable prognostic role. Differences between analytical platforms, inconsistent confounder adjustment and missing biological data complicate interpretation. These findings highlight the need for standardised HCC measurement and stronger longitudinal research before the marker can be meaningfully evaluated in cancer care.

What to keep in mind

Only six studies were included, with variable methodological quality and a predominance of breast cancer studies. Analytical heterogeneity, limited confounder control and missing biological data constrained the evidence.