Studies: No Clear Link Between Stress and Cancer Returning

When treatment ends, cancer survivors begin a new chapter in their lives, one that can bring hope and happiness – but also fear of the cancer coming back. Many survivors feel stress at this point in their cancer journey, while also worrying that the stress itself might increase the chances of recurrence. To examine the relationship between stress and cancer recurrence, researchers from Uniformed Services University of the Health Sciences have reviewed the scientific literature on the topic published from December 1979 through April 2012. They found no clear evidence that stress causes cancer to come back. However, the authors conclude that reducing stress is still beneficial because it can improve emotional well-being and quality of life.

The review is published in the March-April 2014 issue of Cancer Nursing. It analyzes 15 studies that compared stress levels to rates of cancer recurrence. The studies used a variety of methods for determining survivors’ stress levels. Some used questionnaires to find out if survivors were going through stressful events in their lives. Others measured stress through psychological symptoms including depression and anxiety. And the rest measured the levels of certain hormones that are known to be released into the bloodstream when people are under stress for long periods of time.

Most of the studies reported finding no relationship between cancer recurrence and stress. A few did find some relationship, and a few actually found the reverse: less cancer recurrence associated with more stress. Overall, the researchers conclude that the evidence does not show stress causes cancer to come back, although they acknowledge that more research is needed on the subject. The authors write that even though stress was not shown to cause cancer recurrence, stress management is good for survivors’ emotional well-being and quality of life.

Managing stress

Michael Feuerstein, PhD, MPH, an author of the study and also a cancer survivor, said recurrence is a common fear among survivors – and something he has worried about himself. Feuerstein said the study’s findings could come as a relief to many: “I think it will be very helpful to a lot of people, but also controversial because it’s such a common assumption in this day and age that stress causes everything. But in this investigation of scientific literature, the evidence is not there to indicate stress causes recurrence.”

Feuerstein cautioned that survivors still need to take steps to manage their stress as they transition to life after treatment. He said stress can make other things worse, including fatigue, pain, function, motivation, memory, and organizing tasks. He recommends survivors become proactive in taking control over their survivorship. Some strategies for coping include:

  • Exercise. According to Feuerstein, reviews and randomized controlled trials show exercise, even moderate walking, can reduce stress levels, pain, and prolonged sadness.
  • Meditation. Feuerstein said research shows clearly that mindfulness meditation can help with anxiety, which is similar to stress, and also helps improve sleep.
  • Medication, if necessary. A doctor can prescribe antidepressants or other medications to treat severe depression and anxiety.
  • Counseling. Social workers and psychologists can offer stress management techniques. Emotional support is also available through support groups, including online support groups.

Feuerstein said even just recognizing problem areas and taking action on them can help survivors with stress and give them a sense of control – something they may not have had during treatment, when other people were the ones in control.

Feuerstein said these days people are living longer after cancer, and treatment has become much more refined: surgery is more specific, drugs are more tailored, and doses of radiation are lower – all of which reduces the death rate and reduces side effects from treatment. He said people are not necessarily condemned to a “new normal” of stress, pain, or other problems during survivorship, and they need to know it.

“You can be proactive through various management approaches and through improving literacy regarding the healthcare system and access to the healthcare system,” said Feuerstein. “It’s something people can do, but a lot of people don’t. They live with the problems and just put up with it because of this notion that has been around for years that this is the new normal. Evidence is growing to indicate that you don’t need to stay at your new normal. You can return to some close approximation or something even better than your old normal.”

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American Cancer Society news stories are copyrighted material and are not intended to be used as press releases. For reprint requests, please see our Content Usage Policy.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master's-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Stressors, Stress Response, and Cancer Recurrence. Published in the March-April 2014 issue of Cancer Nursing (Vol. 37, NO. 2). First author: Briana L. Todd, MA, MS, Uniformed Services University of the Health Sciences, Bethesda, Md.

American Cancer Society news stories are copyrighted material and are not intended to be used as press releases. For reprint requests, please see our Content Usage Policy.