The influence of psychosocial factors on the development and progression of cancer has been a longstanding hypothesis since ancient times. In fact, epidemiological and clinical studies over the past 30 years have provided strong evidence for links between chronic stress, depression and social isolation and cancer progression. By contrast, there is only limited evidence for the role of these behavioral factors in cancer initiation. Recent cellular and molecular studies have identified specific signaling pathways that impact cancer growth and metastasis. This article provides an overview of the relationship between psychosocial factors, specifically chronic stress, and cancer progression.
Keywordscancer; catecholamine; metastasis; signaling pathway; stress The major cause of death from cancer is metastasis that is resistant to conventional therapy [1]. Primary neoplasms are biologically heterogeneous and the process of metastasis consists of a series of sequential and selective steps that few cells can successfully complete. The outcome of cancer metastasis depends on multiple interactions between metastatic cells and homeostatic mechanisms that are unique to a given organ micro environment [2]. Therefore, the treatment of metastasis should be targeted not only against cancer cells, but also against the host factors that contribute to and support the progressive growth and survival of metastatic cancer cells. Clinical and epidemiological studies over the last 30 years have identified psychosocial factors including stress, chronic depression and lack of social support as risk factors for cancer progression [3][4][5][6]. Whereas evidence for the role of psychosocial factors in cancer initiation is limited and some-what contradictory [7][8][9][10], support is stronger for links between psychological factors such as stress, depression and social isolation and disease progression [11,12]. Chronicity of negative affect, as manifested by depressed mood or hopelessness, appears to have stronger relationships with outcomes
NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript than do stressful events, suggesting that sustained activation of negative affective pathways may provide the strongest links to cancer progression [13][14][15][16]. Moderators of stress, such as social support, have been frequently studied with respect to cancer outcomes. Social support refers to an individual's perceived satisfaction with social relationships and is thought to play a major role in buffering psychological and biological stress responses [17]. Several studies have linked high levels of social support to improved clinical outcomes in cancer patients. For example, in breast cancer patients, social support has been related to longer survival in several large-scale studies [18][19][20], although negative findings were noted in some studies [21][22][23]. Collectively, emerging evidence has shown stress and specific psychosocial factors to be associated with key elements of the metastatic cascade in both animal ...