Do stress-related psychosocial factors contribute to cancer incidence and survival?

Nat Clin Pract Oncol. 2008 Aug;5(8):466-75. doi: 10.1038/ncponc1134. Epub 2008 May 20.


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.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adaptation, Psychological*
  • Causality
  • Comorbidity
  • Disease-Free Survival
  • Female
  • Humans
  • Incidence
  • Male
  • Neoplasm Staging
  • Neoplasms / epidemiology*
  • Neoplasms / psychology*
  • Neoplasms / therapy
  • Quality of Life / psychology*
  • Sickness Impact Profile
  • Social Support
  • Stress, Psychological / epidemiology*
  • Stress, Psychological / prevention & control
  • Survival Analysis