Cancer and stress: NextGen strategies

Brain Behav Immun. 2021 Mar;93:368-383. doi: 10.1016/j.bbi.2020.11.005. Epub 2020 Nov 5.


Chronic stress is well-known to cause physiological distress that leads to body balance perturbations by altering signaling pathways in the neuroendocrine and sympathetic nervous systems. This increases allostatic load, which is the cost of physiological fluctuations that are required to cope with psychological challenges as well as changes in the physical environment. Recent studies have enriched our knowledge about the role of chronic stress in disease development, especially carcinogenesis. Stress stimulates the hypothalamic-pituitaryadrenal (HPA) axis and the sympathetic nervous system (SNS), resulting in an abnormal release of hormones. These activate signaling pathways that elevate expression of downstream oncogenes. This occurs by activation of specific receptors that promote numerous cancer biological processes, including proliferation, genomic instability, angiogenesis, metastasis, immune evasion and metabolic disorders. Moreover, accumulating evidence has revealed that β-adrenergic receptor (ADRB) antagonists and downstream target inhibitors exhibit remarkable anti-tumor effects. Psychosomatic behavioral interventions (PBI) and traditional Chinese medicine (TCM) also effectively relieve the impact of stress in cancer patients. In this review, we discuss recent advances in the underlying mechanisms that are responsible for stress in promoting malignancies. Collectively, these data provide approaches for NextGen pharmacological therapies, PBI and TCM to reduce the burden of tumorigenesis.

Keywords: Cancer; Hypothalamic-pituitary-adrenal (HPA) axis; Psychosomatic behavioral interventions; Stress; Traditional Chinese medicine (TCM); β-Adrenergic blocker.

Publication types

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

MeSH terms

  • Allostasis*
  • Humans
  • Hypothalamo-Hypophyseal System
  • Neoplasms* / therapy
  • Neurosecretory Systems
  • Pituitary-Adrenal System
  • Stress, Physiological
  • Stress, Psychological
  • Sympathetic Nervous System