Stressors, Stress Response, and Cancer Recurrence: A Systematic Review

Todd, Briana L. MA, MS; Moskowitz, Michal C. MS; Ottati, Alicia MA; Feuerstein, Michael PhD, MPH

Cancer Nursing:
doi: 10.1097/NCC.0b013e318289a6e2
Articles
Abstract

Background: Cancer survivors assume that stress plays an important role in cancer recurrence. However, the role of stress in the etiology of cancer recurrence remains unclear.

Objective: A systematic review examining the causal role of exposure to stressors and/or stress response and cancer recurrence was conducted.

Methods: The authors screened the scientific literature published from December 1979 through April 2012. Prospective studies and randomized control trials that examined the link between exposure to stressors and/or stress response and cancer recurrence were included in the review.

Results: Fifteen studies examined exposures to stressors (life event questionnaires) and/or multiple indices of the stress response (mood, anxiety, depression, biological, and immune measures). The relationships between stressors and/or stress response and recurrence were observed as no relationship (80%), positive relationship (33%), and inverse relationship (27%). One of 3 randomized control trials reported a positive relationship between stress reduction and reduced risk of recurrence.

Conclusions: The scientific literature to date indicates no clear evidence for a causal relationship between stress (measured as stressor exposure and/or stress response) and cancer recurrence. Although additional high-quality research is needed to provide a more definitive answer, the evidence to date does not support this hypothesis.

Implications for Practice: Although at present, there is no evidence indicating a causal relationship between stress and cancer recurrence, attending to the reduction in a cancer survivor’s stress response can improve emotional well-being and quality of life.

Author Information

Author Affiliations: Department of Medical and Clinical Psychology (Mss Todd, Moskowitz, Ottati, and Dr Feuerstein) and Department of Preventive Medicine and Biometrics (Dr Feuerstein), Uniformed Services University of the Health Sciences, Bethesda, Maryland.

The opinions and assertions contained herein are the private views of the authors and are not to be construed as being official or as reflecting the views of the Uniformed Services University of the Health Sciences or the Department of Defense.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Michael Feuerstein, PhD, MPH, Department of Medical and Clinical Psychology and Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814 (michael.feuerstein@usuhs.edu).

Accepted for publication January 23, 2013.

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