Review Article | Published:

Do stress-related psychosocial factors contribute to cancer incidence and survival?

Nature Clinical Practice Oncology volume 5, pages 466475 (2008) | Download Citation



A substantial body of research has investigated the associations between stress-related psychosocial factors and cancer outcomes. Previous narrative reviews have been inconclusive. In this Review, we evaluated longitudinal associations between stress and cancer using meta-analytic methods. The results of 165 studies indicate that stress-related psychosocial factors are associated with higher cancer incidence in initially healthy populations (P = 0.005); in addition, poorer survival in patients with diagnosed cancer was noted in 330 studies (P <0.001), and higher cancer mortality was seen in 53 studies (P <0.001). Subgroup meta-analyses demonstrate that stressful life experiences are related to poorer cancer survival and higher mortality but not to an increased incidence. Stress-prone personality or unfavorable coping styles and negative emotional responses or poor quality of life were related to higher cancer incidence, poorer cancer survival and higher cancer mortality. Site-specific analyses indicate that psychosocial factors are associated with a higher incidence of lung cancer and poorer survival in patients with breast, lung, head and neck, hepatobiliary, and lymphoid or hematopoietic cancers. These analyses suggest that stress-related psychosocial factors have an adverse effect on cancer incidence and survival, although there is evidence of publication bias and results should be interpreted with caution.

Key points

  • Combined effects from large numbers of studies suggest that stress-related psychosocial factors have an adverse effect on cancer incidence, prognosis, and mortality, although the presence of publication bias means that these results should be interpreted with caution

  • Stressful life experiences were related to decreased cancer survival and increased mortality

  • Stress-prone personality or unfavorable coping styles and emotional distress or poor quality of life were related to increased cancer incidence, reduced cancer survival and increased cancer mortality; in particular, depression seemed to be the primary driver of adverse effects of emotional distress

  • Poor social support did not contribute to cancer outcomes

  • Psychosocial stress was associated with an increased incidence of lung cancer and reduced survival in patients with breast, lung, head and neck, hepatobiliary, and lymphoid or hematopoietic cancers.

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We are grateful to colleagues in many research centers for providing the additional data required for meta-analysis. This work was funded by the British Heart Foundation, Sumitomo Life Social Welfare Services Foundation, and Cancer Research UK.

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  1. Y Chida is Clinical Research Associate, M Hamer is Senior Research Associate, and A Steptoe is Director of the Psychobiology Group, J Wardle is Director of the Centre for Health Behaviour Research and Professor of Clinical Psychology, Department of Epidemiology and Public Health, University College London, London, UK.

    • Yoichi Chida
    • , Mark Hamer
    • , Jane Wardle
    •  & Andrew Steptoe


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The authors declare no competing financial interests.

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Correspondence to Yoichi Chida.

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