title: 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.
authors.affiliation: Psychobiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK. y.chida@ucl.ac.uk
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Chida
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
authors.forename: Andrew
authors.initials: A
authors.lastname: Steptoe
mesh_terms: D000223:Adaptation, Psychological; D015984:Causality; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology* / Q000517:prevention & control; D016019:Survival Analysis