1) Early studies found associations between psychosocial stress like depression and cancer diagnoses, though determining cause and effect is complex. 2) While some research links psychosocial factors like social support and fighting spirit to cancer outcomes, evidence is mixed as to whether they impact cancer incidence or progression. 3) Psychosocial stress may influence immune system activity like natural killer cells in ways that could accelerate cancer, but biological pathways are not fully understood.

1. Psychosocial stress
and
CANCER
Andreea Lupas,
MD student

2. 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

3. From speculation to proof
• 1893 – London Cancer Hospital
• Of 250 patients admitted, 62% had
experienced a major negative life event before
their diagnosis.

4. 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

5. Depression
An early sign of cancer ?
OR
A promoter of cancer
development?

6. 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.

7. Warrior or dezertor?
• A ‘‘fighting spirit’’  predictor of better cancer prognosis
• A more stoic style  more rapid progression
Mortality at 5 years in the group with
more ‘‘fighting spirit’’ (i.e., assertive,
take charge, optimistic, and goal
directed) was lower than that of the
stoic, hopeless, and helpless group.

8. Social support
• In women
– lower support  higher cancer
incidence
• In men
– the absence of social support 
more rapid progression
Overall – 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.

9. 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)

10. 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.

11. 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 cytotoxicity
measured 1 week after surgery
(a time when NK cell activity
should decrease from baseline)
predicted a longer cancer-free
period over the next 5 years.

12. 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 lymphocytes
The patients whose NK cell numbers and interferon-a-stimulated NK
cell activity increased from baseline over the 6-month period after the
intervention remained free of cancer recurrence for a longer interval.
However, NK cell activity did not predict survival time.

13. The complexity of psychosocial stress
Psychosocial stress
Use of drugs Modified Decreased Decreased
Tabacco neuroendocrine willingness of treatment
Food consumption response seeking medical compliance
advice
Adverse metabolic Affects DNA Delay tumor
conditions repair detection
Increased cancer risk and progression