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Abstract
BACKGROUND It is unclear which psychological factors (stressors, emotional correlates, and psychophysiological markers) induce cancer risk. This currently limits the potential for prevention strategies. PURPOSE The aim of this review is to bring forth evidence of stress as a determinant of cancer risk from a public health perspective, written for a broad public of practitioners and scientists. METHODS Based on a semisystematic literature search, the impact of different aspects/types of stress and the potential physiological and behavioral pathways are summarized, while highlighting further research, public health and clinical implications. RESULTS Between 2007 and 2020, 65 case-control or cohort studies have been identified. Apart from overall cancer ( N = 24), 12 cancer types have been associated with psychological stress with most for breast ( N = 21), colorectal ( N = 11) and lung/prostate/pancreas cancer ( N = 8 each). Although the evidence regarding the mechanisms is still scarce, cancer development in relation to stress might be due to interacting and combined effects of different stress(or) types, but such interaction has not really been tested yet. The path from stress towards cancer incidence consists of a biological pathway with endocrinology and immunology as well as stress-induced behavioral pathways, including smoking, alcoholism, sleep disruption, an unhealthy diet, and low physical activity together with the related phenomenon of obesity. CONCLUSION Not only the stress but also the stress-induced lifestyle should be targeted for cancer prevention and treatment. Future research should include a more diverse spectrum of cancer types (not only hormonal related like breast cancer) and of stress measures while also considering behavioral covariates.
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Affiliation(s)
- Ananyaa Mohan
- Friedman School of Nutrition Science and Policy, Boston, Massachusetts, USA
| | - Inge Huybrechts
- International Agency for Research on Cancer, Nutrition and Metabolism Section, Lyon, France and Departments of
| | - Nathalie Michels
- Public Health and Primary Care
- Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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Yang T, Qiao Y, Xiang S, Li W, Gan Y, Chen Y. Work stress and the risk of cancer: A meta-analysis of observational studies. Int J Cancer 2018; 144:2390-2400. [PMID: 30484859 DOI: 10.1002/ijc.31955] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 10/18/2018] [Indexed: 12/12/2022]
Abstract
Epidemiological studies have explored the relationship between work stress and the risk of cancer, but it remains unclear on whether work stress could increase the risk of cancer, or by other factors such as smoking and physical activity. Our study aimed to investigate the association between work stress and the risk of cancer and in relation to major potential confounding and modifying factors. We systematically searched three electronic databases, hand-searched references and citations of retrieved articles, and consulted experts to identify studies on assessing the association between work stress and the risk of cancer. The relative risks (RRs) of cancer associated with work stress were estimated using a random-effects model, and stratified by exposure measurement, study design, gender, study location, cancer site, smoking, drinking, body mass index, and physical activity. A total of 281,290 participants were included in this analysis. The significant association between work stress and the risk of colorectal (RR = 1.36; 95%CI: 1.16-1.59), lung (RR = 1.24; 95%CI: 1.02-1.49), and esophagus (RR = 2.12; 95%CI: 1.30-3.47) cancers were found. A statistically significant effect of work stress on colorectal cancer risk was observed in North America (RR = 1.51, 95% CI: 1.23-1.86, but not significant in Europe (RR = 1.16, 95% CI: 0.90-1.48). By contrast, a significant association between work stress and esophagus cancer was found in Europe, but not in North America. In addition, we did not observe any association between work stress and the risk of prostate, breast, or ovarian cancers. Findings of our study show that work stress is an important risk factor for colorectal, lung, and esophagus cancers. General public should be aware of the increased risk of cancer in employers with work stress. More efforts should be focused on understanding and studying the potential mechanisms which would help to identify employees at higher risk of these cancers.
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Affiliation(s)
- Tingting Yang
- Department of Nutrition, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Yan Qiao
- Department of Prevention and Healthcare, Tianjin Union Medical Center, Tianjin, People's Republic of China
| | - Siyun Xiang
- Department of Nutrition, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China
| | - Wenzhen Li
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yongchun Chen
- Department of Nutrition, Henan Provincial People's Hospital, Zhengzhou, Henan, People's Republic of China
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Busch EL, Whitsel EA, Kroenke CH, Yang YC. Social relationships, inflammation markers, and breast cancer incidence in the Women's Health Initiative. Breast 2018; 39:63-69. [PMID: 29614476 PMCID: PMC5936641 DOI: 10.1016/j.breast.2018.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/02/2018] [Accepted: 03/26/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Previous research has reported associations between social relationships and carcinogenesis. Inflammation is a potential mediator of these associations. To clarify these links for one tumor site, we examined associations between social relationships, circulating inflammation markers, and breast cancer incidence. MATERIALS AND METHODS Among 132,262 participants from the prospective Women's Health Initiative, we used linear and logistic regression to evaluate associations between social relationship characteristics (social support, social strain, social network size) and inflammation markers of C-reactive protein (CRP) and white blood cell count (WBC). Cox regression was used to evaluate associations between inflammation markers and breast cancer incidence, as well as associations between social relationship characteristics and breast cancer incidence with and without adjustment for inflammation markers. RESULTS Larger social networks were associated with lower continuous CRP (beta = -0.22, 95% CI -0.36, -0.08) and WBC (beta = -0.23, 95% CI -0.31, -0.16). Greater social strain was associated with higher continuous CRP (beta = 0.24, 95% CI 0.14, 0.33) and WBC (beta = 0.09, 95% CI 0.04, 0.14). When WBC was dichotomized at 10,000 cells/uL, high WBC was associated with greater hazards of in situ breast cancer (HR = 1.65, 95% CI 1.17, 2.33) but not invasive breast cancer. Social relationship characteristics were not associated with incidence of invasive or in situ breast cancer. CONCLUSION Larger social networks were associated with lower inflammation and greater social strain was associated with higher inflammation. Higher inflammation might be associated with development of in situ breast cancer, but this appeared to be due to factors other than social relationships.
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Affiliation(s)
- Evan L Busch
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, 181 Longwood Avenue, 3rd Floor, Boston, MA 02115, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA.
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599-7435, USA; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Candyce H Kroenke
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA, 94612 USA.
| | - Yang C Yang
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, 308 W. Rosemary Street, Room #219, Chapel Hill, NC 27516, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Blanc-Lapierre A, Rousseau MC, Parent ME. Perceived Workplace Stress Is Associated with an Increased Risk of Prostate Cancer before Age 65. Front Oncol 2017; 7:269. [PMID: 29181335 PMCID: PMC5693840 DOI: 10.3389/fonc.2017.00269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/26/2017] [Indexed: 12/31/2022] Open
Abstract
Background Evidence is lacking regarding the potential role of chronic psychological stress on cancer incidence. The workplace is reported to be the main source of stress among Canadian men. We examined the association between perceived lifetime workplace stress and prostate cancer (PCa) risk in a large case–control study. Methods Cases were 1,933 men, aged ≤ 75 years, newly diagnosed with PCa in 2005–2009 across hospitals in Montreal, Canada. Concurrently, 1994 population controls frequency-matched on age were randomly selected from the electoral list based on cases’ residential districts. Detailed lifestyle and work histories (including perceived stress, from any type of work stressor, for each job held) were collected during in-person interviews. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between work-related stress and PCa risk in multivariate analyses. Results Over the lifetime, 58% of subjects reported at least one job as stressful. Occupations described as stressful were most often among white-collar workers. Perceived workplace stress duration was associated with a higher risk of PCa (OR = 1.12, 95% CI:1.04–1.20 per 10-year increase) among men younger than 65 years, but not among older men. Associations were similar irrespective of PCa aggressiveness. Frequent or recent screening for PCa, age at first exposure and time since exposure to work-related stress, and socioeconomic and lifestyle factors, had little influence on risk estimates. Conclusion Findings are in line with an association between reporting prolonged workplace stress and an increase in risk of PCa before age 65.
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Affiliation(s)
- Audrey Blanc-Lapierre
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Institut National de la Recherche Scientifique (INRS), University of Quebec, Laval, QC, Canada
| | - Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Institut National de la Recherche Scientifique (INRS), University of Quebec, Laval, QC, Canada.,School of Public Health, Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.,University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
| | - Marie-Elise Parent
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Institut National de la Recherche Scientifique (INRS), University of Quebec, Laval, QC, Canada.,School of Public Health, Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.,University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
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Blanc-Lapierre A, Rousseau MC, Weiss D, El-Zein M, Siemiatycki J, Parent MÉ. Lifetime report of perceived stress at work and cancer among men: A case-control study in Montreal, Canada. Prev Med 2017; 96:28-35. [PMID: 27923666 DOI: 10.1016/j.ypmed.2016.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 11/30/2016] [Accepted: 12/01/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The association between perceived workplace psychological stress, over the entire work career, and cancer among men has never been assessed. This was explored in the context of a population-based case-control study conducted in Montreal, Canada. METHODS 3103 incident cancer cases (11 types) diagnosed in 1979-1985 and 512 population controls were interviewed. Subjects described in detail each job held during their lifetime, including the occurrence of stress, and its reason. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for the association between perceived workplace stress and its duration, and each cancer site, adjusting for lifestyle and occupational factors. RESULTS Employment in at least one stressful job was associated with increased odds of cancers of the lung (OR=1.33, 95% CI: 1.01-1.75), colon (OR=1.51, 95% CI: 1.15-1.98), bladder (OR=1.37, 95% CI: 1.03-1.81), rectal (OR=1.52, 95% CI: 1.10-2.10), and stomach (OR=1.53, 95% CI: 1.08-2.15). A duration-response trend was found for cancers of the lung, colon, rectum, stomach, and for NHL. Subjects reported changes in stress level over their career. Perceived stress was ascribed to several sources, including high demand and time pressure, financial issues, job insecurity, and hazardous conditions. CONCLUSION Prolonged exposure to perceived stress at work was associated with greater odds of cancer at 5 out of 11 sites. While over reporting of stress by cases cannot be fully ruled out, these associations, if substantiated, would bear important public health significance. Prospective studies building on detailed stress assessment protocols considering all sources and changes over the career are necessary.
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Affiliation(s)
- Audrey Blanc-Lapierre
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Institut national de la recherche scientifique (INRS), University of Quebec, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada
| | - Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Institut national de la recherche scientifique (INRS), University of Quebec, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada; School of Public Health, Department of Social and Preventive Medicine, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada; University of Montreal Hospital Research Center (CRCHUM), Tour Saint-Antoine, 850 St. Denis Street, Montreal, QC H2X 0A9, Canada
| | - Deborah Weiss
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Institut national de la recherche scientifique (INRS), University of Quebec, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada
| | - Mariam El-Zein
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Institut national de la recherche scientifique (INRS), University of Quebec, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada
| | - Jack Siemiatycki
- School of Public Health, Department of Social and Preventive Medicine, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada; University of Montreal Hospital Research Center (CRCHUM), Tour Saint-Antoine, 850 St. Denis Street, Montreal, QC H2X 0A9, Canada
| | - Marie-Élise Parent
- Epidemiology and Biostatistics Unit, INRS-Institut Armand-Frappier, Institut national de la recherche scientifique (INRS), University of Quebec, 531 Boulevard des Prairies, Laval, QC H7V 1B7, Canada; School of Public Health, Department of Social and Preventive Medicine, University of Montreal, 7101 Avenue du Parc, Montreal, QC H3N 1X9, Canada; University of Montreal Hospital Research Center (CRCHUM), Tour Saint-Antoine, 850 St. Denis Street, Montreal, QC H2X 0A9, Canada.
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Vesterlund GK, Høeg BL, Johansen C, Heitmann BL, E. Bidstrup P. Prolonged job strain and subsequent risk of cancer in women - a longitudinal study, based on the Danish Nurse Cohort. Acta Oncol 2017; 56:301-306. [PMID: 28093051 DOI: 10.1080/0284186x.2016.1267399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The role of psychological stress in cancer risk is continuously debated. Stress at work is the most common form of stress and previous studies have shown inconsistent results regarding cancer risk. In this longitudinal study, we examined the association between prolonged job strain across six years and subsequent cancer risk. METHODS AND MATERIALS We used data from 6571 cancer-free women from the Danish Nurse Cohort aged 45-70 years at inclusion, and self-reported questionnaires on job strain at baseline in 1993 and again in 1999. Prolonged job strain was defined as high job busyness and speed, and low control in both 1993 and 1999. Information on cancer diagnosis was obtained from the Danish Cancer Registry. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for overall cancer as well as subgroups of virus immune-related, hormone-related, digestive and lung cancers according to level of prolonged job strain. The women were followed from 1 January 2000 until cancer diagnosis, emigration, death or 31 December 2013 (mean follow-up 13 years) and models were adjusted for potential confounders. Effect modification was examined according to working nightshifts and full time. RESULTS No significant differences in the risk of overall cancer or any of the cancer subgroups were identified in relation to prolonged busyness, speed, influence, or overall job strain. Effect modification by working full time was observed when examining job influence in relation to overall cancer risk, and by working nightshifts when examining job influence in relation to hormone related cancer risk. However, none of the associations were significant in stratified analyses. CONCLUSION We found no evidence of an increased risk of any cancer among women with prolonged job strain. Since a large proportion of cancer patients perceive psychological stress as a possible cause of their cancer disease, it is of importance to communicate these findings to the public.
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Affiliation(s)
- Gitte K. Vesterlund
- Survivorship Unit, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Beverley L. Høeg
- Survivorship Unit, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christoffer Johansen
- Survivorship Unit, The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Berit L. Heitmann
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg and Frederiksberg Hospital, Part of Copenhagen University Hospital, Frederiksberg, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Section for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pernille E. Bidstrup
- Survivorship Unit, The Danish Cancer Society Research Center, Copenhagen, Denmark
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Endoh K, Kuriki K, Kasezawa N, Tohyama K, Goda T. Impact of Interactions Between Self-Reported Psychological Stress and Habitual Exercise on the Dietary Intake of Japanese Men and Women: a Large-Scale Cross-Sectional Study. Asian Pac J Cancer Prev 2017; 17:2007-17. [PMID: 27221888 DOI: 10.7314/apjcp.2016.17.4.2007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modifying lifestyle factors such as diet and exercise can reduce the risk of cancer. Psychological stress (PS) might be indirectly associated with cancer because it alters lifestyle factors. However, the relationship among these variables has not been fully investigated. Thus, we examined interactions between self-reported PS (SRPS) and habitual exercise on diet. MATERIALS AND METHODS In all, 5,587 men and 2,718 women were divided into "exerciser" and "non-exerciser" groups, based on whether they exercised regularly, and classified into three SRPS levels: low, moderate and high. Diet was estimated using a validated food frequency questionnaire. Using a general linear model, food and nutrient consumption was estimated for each SRPS level in the 2 exercise groups, and the interactions between SRPS levels and exercise were calculated. RESULTS In women, the intake of pork and beef, low fat milk and yogurt, natto (fermented soybean), carrots and squash, other root vegetables, mushrooms, seaweeds, and wine, along with the nutrients vegetable protein, soluble, insoluble and total dietary fiber, daidzein, genistein, carotene, retinol equivalents, vitamin B2, pantothenic acid, potassium, calcium, magnesium, phosphorus and iron demonstrated significant interaction with SRPS and habitual exercise (p for interaction <0.05). In men, raw and green leafy vegetables and fruit and vegetable juice significantly interacted with SRPS and habitual exercise (p for interaction <0.05). CONCLUSIONS We suggest that certain foods and nutrients, which are thought to have a protective effect against cancer, interact with SRPS and habitual exercise, especially in women. This information is valuable for understanding and improving interventions for cancer prevention.
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Affiliation(s)
- Kaori Endoh
- Laboratory of Public Health, University of Shizuoka, Shizuoka, Japan E-mail :
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Abstract
OBJECTIVE Ovarian cancer (OvCA) is a leading cause of cancer death for women. Depression and social isolation have been associated with a higher OvCA risk and poorer survival, but other forms of chronic psychosocial stress, including work-related characteristics, remain understudied. METHODS Women from three prospective cohorts (Nurses' Health Study: n = 31,754; Nurses' Health Study II: n = 74,260; Northern Sweden Health and Disease Study: nnested case-control study = 196) completed a job questionnaire, assessing demand and control at work, social support provided by coworkers and supervisor, and job security. Multivariate Cox and conditional logistic regression models estimated hazard ratios (Nurses' Health Study/Nurses' Health Study II) and odd ratios (Northern Sweden Health and Disease Study) of OvCA risk and mortality among cases. Random coefficient models were used for meta-analyses. RESULTS There were 396 OvCA cases and 186 deaths during follow-up. Overall, job strain, strain chronicity, social support, and job security were not significantly associated with OvCA risk (e.g., pooled relative risk [RR]high demand/low control = 1.06, confidence interval [CI] = 0.72-1.55) or mortality (e.g., pooled RRhigh demand/low control = 1.08, CI = 0.64-1.82). When considered individually, compared with low levels, only moderate levels of demand were associated with a reduced OvCA risk (pooled RR = 0.66, CI = 0.49-0.90). Social support provided by the coworker or the supervisor did not moderate the association of job strain with either OvCA risk or overall mortality. CONCLUSIONS We did not observe clear associations between work characteristics and OvCA incidence or mortality, but further research with diverse populations is warranted.
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Kim Y, Shin HY, Moon W, Cho SH. Use of complementary and alternative medicine by lung cancer patients in Korea: A qualitative study. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2015.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Padyab M, Blomstedt Y, Norberg M. No association found between cardiovascular mortality, and job demands and decision latitude: Experience from the Västerbotten Intervention Programme in Sweden. Soc Sci Med 2014; 117:58-66. [DOI: 10.1016/j.socscimed.2014.07.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 07/10/2014] [Accepted: 07/13/2014] [Indexed: 01/19/2023]
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Denver P, Donnelly M, Murray LJ, Anderson LA. Psychosocial factors and their association with reflux oesophagitis, Barrett’s oesophagus and oesophageal adenocarcinoma. World J Gastroenterol 2013; 19:1770-1777. [PMID: 23555165 PMCID: PMC3607753 DOI: 10.3748/wjg.v19.i11.1770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 10/24/2012] [Accepted: 11/15/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the role of psychological characteristics as risk factors for oesophageal adenocarcinoma (OAC), as well as the reflux-mediated precursor pathway.
METHODS: An all-Ireland population-based case-control study recruited 230 reflux oesophagitis (RO), 224 Barrett’s oesophagus (BO) and 227 OAC patients and 260 controls. Each case/control group completed measures of stress, depression, self-efficacy, self-esteem, repression and social support. A comparative analysis was undertaken using polytomous logistic regression adjusted for potential confounders.
RESULTS: Compared to controls, OAC patients were almost half as likely to report high stress levels over their lifetime (P = 0.010, OR 0.51; 95%CI: 0.29-0.90) and 36% less likely to report having experienced depression (OR 0.64; 95%CI: 0.42-0.98). RO patients reported significantly higher stress than controls particularly during middle- and senior-years (P for trends < 0.001). RO patients were 37% less likely to report having been highly emotionally repressed (OR 0.63; 95%CI: 0.41-0.95). All case groups (OAC, RO and BO) were more likely than controls to report having had substantial amounts of social support (OR 2.84; 95%CI: 1.63-4.97; OR 1.97; 95%CI: 1.13-3.44 and OR 1.83; 95%CI: 1.03-3.24, respectively).
CONCLUSION: The improved psychological profile of OAC patients may be explained by response shift. The role of psychological factors in the development of OAC requires further investigation.
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Heikkilä K, Nyberg ST, Theorell T, Fransson EI, Alfredsson L, Bjorner JB, Bonenfant S, Borritz M, Bouillon K, Burr H, Dragano N, Geuskens GA, Goldberg M, Hamer M, Hooftman WE, Houtman IL, Joensuu M, Knutsson A, Koskenvuo M, Koskinen A, Kouvonen A, Madsen IEH, Magnusson Hanson LL, Marmot MG, Nielsen ML, Nordin M, Oksanen T, Pentti J, Salo P, Rugulies R, Steptoe A, Suominen S, Vahtera J, Virtanen M, Väänänen A, Westerholm P, Westerlund H, Zins M, Ferrie JE, Singh-Manoux A, Batty GD, Kivimäki M. Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116,000 European men and women. BMJ 2013; 346:f165. [PMID: 23393080 PMCID: PMC3567204 DOI: 10.1136/bmj.f165] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers. DESIGN Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116,056 men and women aged 17-70 who were free from cancer at study baseline and were followed-up for a median of 12 years. Work stress was measured and defined as job strain, which was self reported at baseline. Incident cancers (all n=5765, colorectal cancer n=522, lung cancer n=374, breast cancer n=1010, prostate cancer n=865) were ascertained from cancer, hospital admission, and death registers. Data were analysed in each study with Cox regression and the study specific estimates pooled in meta-analyses. Models were adjusted for age, sex, socioeconomic position, body mass index (BMI), smoking, and alcohol intake RESULTS A harmonised measure of work stress, high job strain, was not associated with overall risk of cancer (hazard ratio 0.97, 95% confidence interval 0.90 to 1.04) in the multivariable adjusted analyses. Similarly, no association was observed between job strain and the risk of colorectal (1.16, 0.90 to 1.48), lung (1.17, 0.88 to 1.54), breast (0.97, 0.82 to 1.14), or prostate (0.86, 0.68 to 1.09) cancers. There was no clear evidence for an association between the categories of job strain and the risk of cancer. CONCLUSIONS These findings suggest that work related stress, measured and defined as job strain, at baseline is unlikely to be an important risk factor for colorectal, lung, breast, or prostate cancers.
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Fransson EI, Nyberg ST, Heikkilä K, Alfredsson L, Bacquer DD, Batty GD, Bonenfant S, Casini A, Clays E, Goldberg M, Kittel F, Koskenvuo M, Knutsson A, Leineweber C, Magnusson Hanson LL, Nordin M, Singh-Manoux A, Suominen S, Vahtera J, Westerholm P, Westerlund H, Zins M, Theorell T, Kivimäki M. Comparison of alternative versions of the job demand-control scales in 17 European cohort studies: the IPD-Work consortium. BMC Public Health 2012; 12:62. [PMID: 22264402 PMCID: PMC3328260 DOI: 10.1186/1471-2458-12-62] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 01/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Job strain (i.e., high job demands combined with low job control) is a frequently used indicator of harmful work stress, but studies have often used partial versions of the complete multi-item job demands and control scales. Understanding whether the different instruments assess the same underlying concepts has crucial implications for the interpretation of findings across studies, harmonisation of multi-cohort data for pooled analyses, and design of future studies. As part of the 'IPD-Work' (Individual-participant-data meta-analysis in working populations) consortium, we compared different versions of the demands and control scales available in 17 European cohort studies. METHODS Six of the 17 studies had information on the complete scales and 11 on partial scales. Here, we analyse individual level data from 70 751 participants of the studies which had complete scales (5 demand items, 6 job control items). RESULTS We found high Pearson correlation coefficients between complete scales of job demands and control relative to scales with at least three items (r > 0.90) and for partial scales with two items only (r = 0.76-0.88). In comparison with scores from the complete scales, the agreement between job strain definitions was very good when only one item was missing in either the demands or the control scale (kappa > 0.80); good for job strain assessed with three demand items and all six control items (kappa > 0.68) and moderate to good when items were missing from both scales (kappa = 0.54-0.76). The sensitivity was > 0.80 when only one item was missing from either scale, decreasing when several items were missing in one or both job strain subscales. CONCLUSIONS Partial job demand and job control scales with at least half of the items of the complete scales, and job strain indices based on one complete and one partial scale, seemed to assess the same underlying concepts as the complete survey instruments.
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Affiliation(s)
- Eleonor I Fransson
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden.
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Stilley CS, Flynn WB, Sereika SM, Stimer ED, DiMartini AF, deVera ME. Pathways of psychosocial factors, stress, and health outcomes after liver transplantation. Clin Transplant 2011; 26:216-22. [PMID: 21518004 DOI: 10.1111/j.1399-0012.2011.01467.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The impact of stress and individual factors on health outcomes in general medicine and transplantation are well documented. Few researchers have investigated the complex relationships between these constructs. This longitudinal study assessed coping style, self-regulatory ability, hostility, and social support at baseline among a cohort of 130 adult liver transplant recipients at the Starzl Transplant Institute, University of Pittsburgh Medical Center, and followed those subjects with interview and medical records data about personal and transplant-related stress, physical and mental health outcomes throughout the first post-transplant year. Results show a number of strong bidirectional relationships between coping style, self-regulatory ability, hostility, the caregiver relationship and family environment, personal and transplant-related stress over the second half of the first post-transplant year, and health (especially mental) outcomes at 12 months post-transplant. Stress mediates the relationship between psychosocial factors and mental health outcomes. The importance of those relationships to researchers and clinicians is discussed.
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Affiliation(s)
- Carol S Stilley
- University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.
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