title: Stressors, stress response, and cancer recurrence: a systematic review.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Briana L
authors.initials: BL
authors.lastname: Todd
authors.forename: Michal C
authors.initials: MC
authors.lastname: Moskowitz
authors.forename: Alicia
authors.initials: A
authors.lastname: Ottati
authors.forename: Michael
authors.initials: M
authors.lastname: Feuerstein
mesh_terms: D001007:Anxiety / Q000451:nursing*; D003863:Depression / Q000451:nursing*; D019317:Evidence-Based Medicine; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000451:nursing* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013315:Stress, Psychological / Q000451:nursing*; D017741:Survivors / Q000523:psychology