Psychological Stress and Cancer (Fact Sheet)

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 promoteangiogenesis and metastasis.