Psychological Stress and Cancer (Fact Sheet)

In another study, women with triple-negative breast cancer who had been treated withneoadjuvant 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

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]

Source: National Cancer Institute