Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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

Abstract

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.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Figure 1: Flow diagram of systematic review (QUOROM statement flow diagram).
Figure 2: The effect of stress-related psychosocial factors on cancer incidence: results of meta-analyses, subgrouping, and sensitivity analyses.
Figure 3: The effect of stress-related psychosocial factors on cancer survival: results of meta-analyses, subgrouping, and sensitivity analyses.
Figure 4: The effect of stress-related psychosocial factors on cancer mortality: results of meta-analyses, subgrouping, and sensitivity analyses.

References

  1. 1

    Brock AJ (1929) Greek medicine: being extracts illustrative of medical writers from Hippocrates to Galen. London and Toronto: JM Dent and Sons

  2. 2

    Colditz GA et al. (2006) Epidemiology—identifying the causes and preventability of cancer? Nat Rev Cancer 6: 75–83

    CAS  Article  Google Scholar 

  3. 3

    Lutgendorf SK et al. (2007) Psychosocial influences in oncology: an expanded model of biobehavioral mechanisms. In Psychoneuroimmunology, 869–895 (Ed. Ader R) Amsterdam: Academic Press

    Chapter  Google Scholar 

  4. 4

    Denollet J (1999) Personality and cancer. Curr Opin Psychiatry 12: 743–748

    Article  Google Scholar 

  5. 5

    Edelman S and Kidman AD (1997) Mind and cancer: is there a relationship? A review of evidence. Aust Psychologist 32: 79–85

    Article  Google Scholar 

  6. 6

    McGee R et al. (1994) Depression and the development of cancer: a meta-analysis. Soc Sci Med 38: 187–192

    CAS  Article  Google Scholar 

  7. 7

    Duijts SFA et al. (2003) The association between stressful life events and breast cancer risk: a meta-analysis. Int J Cancer 107: 1023–1029

    CAS  Article  Google Scholar 

  8. 8

    Petticrew M et al. (2002) Influence of psychological coping on survival and recurrence in people with cancer: systematic review. BMJ 325: 1066–1069

    Article  Google Scholar 

  9. 9

    Megdal SP et al. (2005) Night work and breast cancer risk: a systematic review and meta-analysis. Eur J Cancer 41: 2023–2032

    Article  Google Scholar 

  10. 10

    Sanderman R and Ranchor AV (1997) The predictor status of personality variables: Etiological significance and their role in the course of disease. Eur J Person 11: 359–382

    Article  Google Scholar 

  11. 11

    Petticrew M et al. (1999) Adverse life-events and risk of breast cancer: a meta-analysis. Br J Health Psychol 4: 1–17

    Google Scholar 

  12. 12

    Spiegel D and Giese-Davis J (2003) Depression and cancer: mechanisms and disease progression. Biol Psychiatry 54: 269–282

    Article  Google Scholar 

  13. 13

    Bleiker EMA and van der Ploeg HM (1999) Psychosocial factors in the etiology of breast cancer: review of a popular link. Patient Educ Couns 37: 201–214

    CAS  Article  Google Scholar 

  14. 14

    McKenna MC et al. (1999) Psychosocial factors and the development of breast cancer: a meta-analysis. Health Pschol 18: 520–531

    CAS  Article  Google Scholar 

  15. 15

    Butow PN et al. (2000) Epidemiological evidence for a relationship between life events, coping style, and personality factors in the development of breast cancer. J Psychosom Med 49: 169–181

    CAS  Article  Google Scholar 

  16. 16

    Gerits P (2000) Life events, coping and breast cancer: state of the art. Biomed Psychother 54: 229–233

    CAS  Google Scholar 

  17. 17

    Nielsen NR and Grønbæk M (2006) Stress and breast cancer: a systematic update on the current knowledge. Nat Clin Pract Oncol 3: 612–620

    Article  Google Scholar 

  18. 18

    Dalton SO et al. (2002) Mind and cancer: do psychological factors cause cancer? Eur J Cancer 38: 1313–1323

    CAS  Article  Google Scholar 

  19. 19

    Garssen B (2004) Psychological factors and cancer development: evidence after 30 years of research. Clin Psychol Rev 24: 315–338

    Article  Google Scholar 

  20. 20

    Reiche EMV et al. (2004) Stress, depression, the immune system, and cancer. Lancet Oncol 5: 617–625

    CAS  Article  Google Scholar 

  21. 21

    McEwen BS (1998) Protective and damaging effects of stress mediators. N Engl J Med 338: 171–179

    CAS  Article  Google Scholar 

  22. 22

    Antoni MH et al. (2006) The influence of bio-behavioural factors on tumour biology: pathways and mechanisms. Nat Rev Cancer 6: 240–248

    CAS  Article  Google Scholar 

  23. 23

    Stroup DF et al. (2000) Meta-analysis of observational studies in epidemiology. JAMA 283: 2008–2012

    CAS  Article  Google Scholar 

  24. 24

    LeLorier J et al. (1997) Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med 337: 536–542

    CAS  Article  Google Scholar 

  25. 25

    Spiegel D (2002) Effects of psychotherapy on cancer survival. Nat Rev Cancer 2: 1–6

    Article  Google Scholar 

  26. 26

    Coyne JC et al. (2007) Psychotherapy and survival in cancer: the conflict between hope and evidence. Psychol Bull 133: 367–394

    Article  Google Scholar 

  27. 27

    Creed F and Dickens C (2007) Depression in the medically ill. In Depression and physical illness, 3–18 (Ed. Steptoe A). Cambridge: Cambridge University Press

    Google Scholar 

  28. 28

    Kiecolt-Glaser JK et al. (1985) Distress and DNA repair in human lymphocytes. J Behav Med 8: 311–320

    CAS  Article  Google Scholar 

  29. 29

    Yang E and Glaser R (2003) Stress-induced immunomodulation: implications for tumorigenesis. Brain Behav Immun 17: S37–S40

    Article  Google Scholar 

  30. 30

    Sephton S and Spiegel D (2003) Circadian disruption in cancer: a neuroendocrine-immune pathway from stress to disease? Brain Behav Immun 17: 321–328

    CAS  Article  Google Scholar 

  31. 31

    Sood AK et al. (2006) Stress hormone-mediated invasion of ovarian cancer cells. Clin Cancer Res 12: 369–375

    CAS  Article  Google Scholar 

  32. 32

    Steptoe A et al. (2007) The effect of acute psychological stress on circulating inflammatory factors in humans: a review and meta-analysis. Brain Behav Immun 21: 901–912

    CAS  Article  Google Scholar 

  33. 33

    Segerstrom SC and Miller GE (2004) Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull 130: 601–630

    Article  Google Scholar 

  34. 34

    Tan T-T and Coussens LM (2007) Humoral immunity, inflammation and cancer. Curr Opin Immun 19: 209–216

    CAS  Article  Google Scholar 

  35. 35

    Crulich AE et al. (2007) Incidence of cancers in people with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis. Lancet 370: 59–67

    Article  Google Scholar 

  36. 36

    Raison CL et al. (2006) Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol 27: 24–31

    CAS  Article  Google Scholar 

Download references

Acknowledgements

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Yoichi Chida.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Chida, Y., Hamer, M., Wardle, J. et al. Do stress-related psychosocial factors contribute to cancer incidence and survival?. Nat Rev Clin Oncol 5, 466–475 (2008). https://doi.org/10.1038/ncponc1134

Download citation

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing