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.
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.
About this article
Cognitive Therapy and Research (2019)