Mind and cancer: Is there a relationship? — A review of evidence

Molecular relation between biological stress and carcinogenesis

This paper aims to overview different types of stress, including DNA replication stress, oxidative stress, and psychological stress. Understanding the processes that constitute a cellular response to varied types of stress lets us find differences in how normal cells and cancer cells react to the appearance of a particular kind of stressor. The revealed dissimilarities are the key for targeting new molecules and signaling pathways in anticancer treatment. For this reason, molecular mechanisms that underlay DNA replication stress, oxidative stress, and psychological stress have been studied and briefly presented to indicate biochemical points that make stressors contribute to cancer development. What is more, the viewpoint in which cancer constitutes the outcome and the cause of stress has been taken into consideration. In a described way, this paper draws attention to the problem of cancer-related post-traumatic stress disorder and proposes a novel, multidimensional oncological approach, connecting anticancer treatment with psychiatric support.

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

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.

Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynaecological cancer

BACKGROUND

Demoralisation is a dysphoric mood state commonly seen in the medically ill. Its core features comprise hopelessness, helplessness, loss of purpose and meaning, despair, and existential distress. Sense of Coherence (SOC) is a quantifiable dispositional orientation that captures the character traits likely to protect against demoralisation. In this study, we hypothesised on theoretical grounds that a strong SOC would be associated with lower levels of demoralisation in the context of gynaecological cancer (GC).

METHOD

One hundred and twenty women with a recent (<12 months) diagnosis of GC were recruited from outpatient clinics. Participants were interviewed and completed questionnaire measures of demoralisation and SOC. A multiple regression analysis was performed using the five subscales of the Demoralisation Scale as predictor variables and SOC as the dependent variable.

RESULTS

Together, the five subscales of the Demoralisation Scale accounted for 60% of the variance in SOC.

CONCLUSIONS

The results supported the hypothesis, suggesting that SOC may be protective against demoralisation in the context of serious illness. Larger, multivariate studies that examine additional variables (such as coping) would be required to further clarify the relationship between SOC and demoralisation. In the meantime, clinicians may want to consider efforts to enhance SOC in patients.

Psychological factors and cancer development: Evidence after 30 years of research

The question whether psychological factors affect cancer development has intrigued both researchers and patients. This review critically summarizes the findings of studies that have tried to answer this question in the past 30 years. Earlier reviews, including meta-analyses, covered only a limited number of studies, and included studies with a questionable design (group-comparison, cross-sectional or semiprospective design). This review comprises only longitudinal, truly prospective studies (N=70). It was concluded that there is not any psychological factor for which an influence on cancer development has been convincingly demonstrated in a series of studies. Only in terms of 'an influence that cannot be totally dismissed,' some factors emerged as 'most promising': helplessness and repression seemed to contribute to an unfavorable prognosis, while denial/minimizing seemed to be associated with a favorable prognosis. Some, but even less convincing evidence, was found that having experienced loss events, a low level of social support, and chronic depression predict an unfavorable prognosis. The influences of life events (other than loss events), negative emotional states, fighting spirit, stoic acceptance/fatalism, active coping, personality factors, and locus of control are minor or absent. A methodological shortcoming is not to have investigated the interactive effect of psychological factors, demographic, and biomedical risk factors.

Is there a link between work‐related stress and colorectal cancer?

The South Australian Workers Compensation Tribunal has found that stress contributed to a man's colorectal cancer. The medical evidence for this is very limited, and the case highlights the difference between scientific and legal proof.

Can psycotherapy increase the survival time of cancer patients?

OBJECTIVE

The aim of this paper was to review the evidence regarding the possibility of a relationship between psychological intervention and survival time of cancer patients.

METHOD

A literature search was conducted using CD ROM databases to identify studies which have evaluated the effects of psychological interventions on the survival time of cancer patients. The identified studies were critically reviewed.

RESULTS

Eight studies which used scientifically acceptable methodology to examine this question were identified. Three of these studies found evidence for a relationship between psychological intervention and patients' survival time, while five did not. Methodological issues and potentially confounding factors are discussed.

CONCLUSION

To date, a direct relationship between psychological intervention and patient survival time has not been conclusively demonstrated. Large-scale replication studies which are currently under way will provide more conclusive evidence on this question within the next few years.

Effects of group CBT on the survival time of patients with metastatic breast cancer

We have recently reported the psychological outcome of a group Cognitive Behaviour Therapy (CBT) intervention with patients who had metastatic breast cancer. The data of 92 patients who were retained at the first follow-up assessment revealed short-term improvements on measures of mood and self-esteem amongst therapy participants. These changes were not sustained at the 3- and 6-month follow-up assessments. This report describes a survival analysis of 121 patients who entered the study, at 5 years after its commencement. The analysis, based on the Cox Proportional Hazards Regression model, revealed no survival advantage associated with the intervention. Only medical prognostic factors such as Eastern Cooperative Oncology Group (ECOG) performance status, visceral metastases and chemotherapy treatment significantly predicted patients' survival time. The findings of this study are compared with those of two earlier studies which also examined the survival effects of a group psychological intervention with metastatic breast cancer patients.