Can stress promote the pathophysiology of brain metastases? A critical review of biobehavioral mechanisms

Brain Behav Immun. 2020 Jul;87:860-880. doi: 10.1016/j.bbi.2019.12.013. Epub 2019 Dec 24.


Chronic stress can promote tumor growth and progression through immunosuppressive effects and bi-directional interactions between tumor cells and their microenvironment. β-Adrenergic receptor signaling plays a critical role in mediating stress-related effects on tumor progression. Stress-related mechanisms that modulate the dissemination of tumor cells to the brain have received scant attention. Brain metastases are highly resistant to chemotherapy and contribute considerably to morbidity and mortality in various cancers, occurring in up to 20% of patients in some cancer types. Understanding the mechanisms promoting brain metastasis could help to identify interventions that improve disease outcomes. In this review, we discuss biobehavioral, sympathetic, neuroendocrine, and immunological mechanisms by which chronic stress can impact tumor progression and metastatic dissemination to the brain. The critical role of the inflammatory tumor microenvironment in tumor progression and metastatic dissemination to the brain, and its association with stress pathways are delineated. We also discuss translational implications for biobehavioral and pharmacological interventions.

Keywords: Angiogenesis; Brain metastasis; Immunity; Inflammation; Stress; Tumor microenvironment.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Brain Neoplasms*
  • Humans
  • Receptors, Adrenergic, beta
  • Signal Transduction
  • Tumor Microenvironment*


  • Receptors, Adrenergic, beta