Psychosocial stress and CANCER Andreea Lupas, MD student
Cancer• A disease known from antiquity• Hippocrates and Galen => attributed cancer to the influence of the mind over the body- cancer caused by a melancholic disposition
From speculation to proof• 1893 – London Cancer Hospital• Of 250 patients admitted, 62% had experienced a major negative life event before their diagnosis.
Depression• predicts cancer diagnoses 10 years post- assessment• associated with a cancer diagnosis earlier in life• patients with both cancer and comorbid depression may progress faster ! Some antidepressant drugs may promote tumor growth => confounding factor
DepressionAn early sign of cancer ? ORA promoter of cancerdevelopment?
Psychotic disorders• Schizophrenia- associated with lower cancer mortality. ! Use of neuroleptics – confounding factor?• Fox (1999) showed that increased premature deaths from causes such as suicide artifactually lowers the percentage of deaths from cancer in schizophrenic samples.
Warrior or dezertor?• A ‘‘fighting spirit’’ predictor of better cancer prognosis• A more stoic style more rapid progressionMortality at 5 years in the group withmore ‘‘fighting spirit’’ (i.e., assertive,take charge, optimistic, and goaldirected) was lower than that of thestoic, hopeless, and helpless group.
Social support• In women– lower support higher cancer incidence• In men– the absence of social support more rapid progressionOverall – social support – beneficial by retarding cancer progression,but not by preventing its occurrence (Fox 1999) Reynolds P, Kaplan GA. Social connections and risk for cancer: prospective evidence from the Alameda County Study. Behav Med 1990;16:101–110.
Life events• Metaanalytic methodology have found no support for the effect of stressful life events on the incidence of breast cancer in particular. ‘‘Stressful events do not occur more often among those who later get cancer, die of it, or survive a shorter time.’’ (Fox 1999)
Psychotherapy• Spiegel et al. (1989) reported that group psychosocial treatment significantly increased longevity in patients with breast cancer.• Fox (1999) - saw mixed evidence regarding a positive effect of psychosocial treatment on cancer progression.• Goodwin et al. (2001) did not find support for psychosocial treatment as a factor in longevity, although there were improvements in mental well-being for the patients receiving such treatment.
Immune Mediation of Psychosocial Stress • Levy (1985) - women diagnosed with breast cancer who were rated as being better adjusted to the disease (not distraught) and who reported higher fatigue had lower natural killer (NK) cell numbers. - women with higher social support tended to have higher NK cell activity.Higher NK cell cytotoxicitymeasured 1 week after surgery(a time when NK cell activityshould decrease from baseline)predicted a longer cancer-freeperiod over the next 5 years.
Immune Mediation of Psychosocial Stress• Fawzy et al. (1993) melanoma patients receiving psychosocial therapy: - lower mortality - decreased distress - increase in active coping - increased number of large granular lymphocytesThe patients whose NK cell numbers and interferon-a-stimulated NKcell activity increased from baseline over the 6-month period after theintervention remained free of cancer recurrence for a longer interval.However, NK cell activity did not predict survival time.
The complexity of psychosocial stress Psychosocial stressUse of drugs Modified Decreased DecreasedTabacco neuroendocrine willingness of treatmentFood consumption response seeking medical compliance adviceAdverse metabolic Affects DNA Delay tumorconditions repair detection Increased cancer risk and progression