Psychological Stress and Cancer

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What is psychological stress?

Psychological stress describes what people feel when they are under mental, physical, or emotional pressure. Although it is normal to experience some psychological stress from time to time, people who experience high levels of psychological stress or who experience it repeatedly over a long period of time may develop health problems (mental and/or physical).

Stress can be caused both by daily responsibilities and routine events, as well as by more unusual events, such as a trauma or illness in oneself or a close family member. When people feel that they are unable to manage or control changes caused by cancer or normal life activities, they are in distress. Distress has become increasingly recognized as a factor that can reduce the quality of life of cancer patients. There is even some evidence that extreme distress is associated with poorer clinical outcomes. Clinical guidelines are available to help doctors and nurses assess levels of distress and help patients manage it.

This fact sheet provides a general introduction to the stress that people may experience as they cope with cancer. More detailed information about specific psychological conditions related to stress can be found in the Related Resources and Selected References at the end of this fact sheet.

How does the body respond during stress?

The body responds to physical, mental, or emotional pressure by releasing stress hormones (such as epinephrine and norepinephrine) that increase blood pressure, speed heart rate, and raise blood sugar levels. These changes help a person act with greater strength and speed to escape a perceived threat.

Research has shown that people who experience intense and long-term (i.e., chronic) stress can have digestive problems, fertility problems, urinary problems, and a weakened immune system. People who experience chronic stress are also more prone to viral infections such as the flu or common cold and to have headaches, sleep trouble, depression, and anxiety.

Can psychological stress cause cancer?

Although stress can cause a number of physical health problems, the evidence that it can cause cancer is weak. Some studies have indicated a link between various psychological factors and an increased risk of developing cancer, but others have not.

Apparent links between psychological stress and cancer could arise in several ways. For example, people under stress may develop certain behaviors, such as smoking, overeating, or drinking alcohol, which increase a person’s risk for cancer. Or someone who has a relative with cancer may have a higher risk for cancer because of a shared inherited risk factor, not because of the stress induced by the family member’s diagnosis.

How does psychological stress affect people who have cancer?

People who have cancer may find the physical, emotional, and social effects of the disease to be stressful. Those who attempt to manage their stress with risky behaviors such as smoking or drinking alcohol or who become more sedentary may have a poorer quality of life after cancer treatment. In contrast, people who are able to use effective coping strategies to deal with stress, such as relaxation and stress management techniques, have been shown to have lower levels of depression, anxiety, and symptoms related to the cancer and its treatment. However, there is no evidence that successful management of psychological stress improves cancer survival.

Evidence from experimental studies does suggest that psychological stress can affect a tumor’s ability to grow and spread. For example, some studies have shown that when mice bearing human tumors were kept confined or isolated from other mice—conditions that increase stress—their tumors were more likely to grow and spread (metastasize). In one set of experiments, tumors transplanted into the mammary fat pads of mice had much higher rates of spread to the lungs and lymph nodes if the mice were chronically stressed than if the mice were not stressed. Studies in mice and in human cancer cells grown in the laboratory have found that the stress hormone norepinephrine, part of the body’s fight-or-flight response system, may promote angiogenesis and metastasis.

In another study, women with triple-negative breast cancer who had been treated with neoadjuvant chemotherapy were asked about their use of beta blockers, which are medications that interfere with certain stress hormones, before and during chemotherapy. Women who reported using beta blockers had a better chance of surviving their cancer treatment without a relapse than women who did not report beta blocker use. There was no difference between the groups, however, in terms of overall survival.

Although there is still no strong evidence that stress directly affects cancer outcomes, some data do suggest that patients can develop a sense of helplessness or hopelessness when stress becomes overwhelming. This response is associated with higher rates of death, although the mechanism for this outcome is unclear. It may be that people who feel helpless or hopeless do not seek treatment when they become ill, give up prematurely on or fail to adhere to potentially helpful therapy, engage in risky behaviors such as drug use, or do not maintain a healthy lifestyle, resulting in premature death.

How can people who have cancer learn to cope with psychological stress?

Emotional and social support can help patients learn to cope with psychological stress. Such support can reduce levels of depression, anxiety, and disease- and treatment-related symptoms among patients. Approaches can include the following:

  • Training in relaxation, meditation, or stress management
  • Counseling or talk therapy
  • Cancer education sessions
  • Social support in a group setting
  • Medications for depression or anxiety
  • Exercise

More information about how cancer patients can cope with stress can be found in the PDQ® summaries listed in the Related Resources section at the end of this fact sheet.

Some expert organizations recommend that all cancer patients be screened for distress early in the course of treatment. A number also recommend re-screening at critical points along the course of care. Health care providers can use a variety of screening tools, such as a distress scale or questionnaire, to gauge whether cancer patients need help managing their emotions or with other practical concerns. Patients who show moderate to severe distress are typically referred to appropriate resources, such as a clinical health psychologist, social worker, chaplain, or psychiatrist.

Selected References
  1. Artherholt SB, Fann JR. Psychosocial care in cancer. Current Psychiatry Reports 2012;14(1):23-29.

    [PubMed Abstract]
  2. Fashoyin-Aje LA, Martinez KA, Dy SM. New patient-centered care standards from the Commission on Cancer: opportunities and challenges. Journal of Supportive Oncology 2012; e-pub ahead of print March 20, 2012.

    [PubMed Abstract]
  3. Lutgendorf SK, DeGeest K, Dahmoush L, et al. Social isolation is associated with elevated tumor norepinephrine in ovarian carcinoma patients. Brain, Behavior, and Immunity 2011;25(2):250-255.

    [PubMed Abstract]
  4. Lutgendorf SK, Sood AK, Anderson B, et al. Social support, psychological distress, and natural killer cell activity in ovarian cancer. Journal of Clinical Oncology 2005;23(28):7105-7113.

    [PubMed Abstract]
  5. Lutgendorf SK, Sood AK, Antoni MH. Host factors and cancer progression: biobehavioral signaling pathways and interventions. Journal of Clinical Oncology 2010;28(26):4094-4099.

    [PubMed Abstract]
  6. McDonald PG, Antoni MH, Lutgendorf SK, et al. A biobehavioral perspective of tumor biology. Discovery Medicine 2005;5(30):520-526.

    [PubMed Abstract]
  7. Melhem-Bertrandt A, Chavez-Macgregor M, Lei X, et al. Beta-blocker use is associated with improved relapse-free survival in patients with triple-negative breast cancer. Journal of Clinical Oncology 2011;29(19):2645-2652.

    [PubMed Abstract]
  8. Moreno-Smith M, Lutgendorf SK, Sood AK. Impact of stress on cancer metastasis. Future Oncology 2010;6(12):1863-1881.

    [PubMed Abstract]
  9. Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological Bulletin 2004;130(4):601-630.

    [PubMed Abstract]
  10. Sloan EK, Priceman SJ, Cox BF, et al. The sympathetic nervous system induces a metastatic switch in primary breast cancer. Cancer Research 2010;70(18):7042-7052.

    [PubMed Abstract]
  • Reviewed: December 10, 2012

