State of the Science: Stress, Inflammation, and Cancer

distress, anti-inflammatory agents
ONF 2014, 41(5), 533-540. DOI: 10.1188/14.ONF.533-540

Diagnosis with a life-threatening illness such as cancer is almost universally experienced as stressful. The construct of stress has received substantial consideration as a correlate or predictor of psychological and health outcomes (Andersen et al., 2004) and has often been conceptualized within a stress and coping framework (Lazarus & Folkman, 1984). Biobehavioral factors have long been thought to affect many health processes. The relationship between inflammation of stress and cancer originated centuries ago and is now recognized as a facilitating characteristic of cancer (Mantovani, Allavena, Sica, & Balkwill, 2008). In addition, stress and the stress response are probable mediators of the effects of psychological factors on cancer, and specifically on progression of cancer (Powell, Tarr, & Sheridan, 2013). A substantial amount of new research activity has enlightened scientists and clinicians on the neuroendocrine regulatory function of physiologic pathways in cancer growth and progression (Lutgendorf & Sood, 2011). However, in spite of considerable research over the past several decades, inconsistent data remain a challenge in establishing evidence-based pathways between behavioral risk factors and cancer initiation.

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    Aggarwal, B. B., Shishodia, S., Sandur, S. K., Pandey, M. K., & Sethi, G. (2006). Inflammation and the pathogenesis of depression. Trends in Immunology, 27, 24-31.
    Aggarwal, B. B., Vijayalekshmi, R. V., & Sung, B. (2009). Targeting inflammatory pathways for prevention and therapy of cancer: Short-term friend, long-term foe. Clinical Cancer Research, 15, 425-430.
    Allavena, P., Garlanda, C., Borrello, M., Sica, A., & Mantovani, A. (2008). Pathways connecting inflammation and cancer. Current Opinion in Genetics and Development, 8, 3-10.
    Andersen, B. L., Farrar, W. B., Golden-Kruetz, D. M., Glaser, R., Emery, C. F., Crespin, T. R., … Carson, W. E. (2004). Psychological, behavioral, and immune changes after a psychological intervention: A clinical trial. Journal of Clinical Oncology, 22, 3570-3580.
    Andersen, B. L., Kiecolt-Glaser, J. K., & Glaser, R. (1994). A biobehavioral model of cancer stress and disease course. American Psychologist, 49, 389-404.
    Andersen, B. L., Thornton, L. M., Shapiro, C. L., Farrar, W. B., Mundy, B. L., Yang, H. C., & Carson, W. E. (2010). Biobehavioral, immune and health benefits following recurrence for psychological intervention participants. Clinical Cancer Review, 16, 3270-3278.
    Andersen, B.L, Yang, H. C., Farrar, W. B., Golden-Kreutz, D. M., Emery, C. F., Thorton, L. M., … Carson, W. E. (2008). Psychologic intervention improves survival for breast cancer patients: A randomized clinical trial. Cancer, 113, 3450-3458. doi:10.1002/cncr.23969
    Antoni, M. (2013). Psychosocial intervention effects on adaptation, disease course, and biobehavioral processes in cancer. Brain, Behavior, and Immunity, 30, S88-S98.
    Antoni, M., Lutgendorf, S., Cole, S., Dhabhar, F., Sephton, S., McDonald, P., … Sood, A. (2006). The influence of biobehavioral factors on tumor biology: Pathways and mechanisms. Nature Reviews. Cancer, 6, 240-248.
    Armaiz-Pena, G., Cole, S., Lutgendorf, S., & Sood, A. (2013). Neuroendocrine influences on cancer progression. Brain, Behavior, and Immunity, 30(Suppl.), S19-S25.
    Armaiz-Pena, G., Lutgendorf, S., Cole, S., & Sood, A. (2009). Neuroendocrine modulation of cancer progression. Brain, Behavior, and Immunity, 223, 10-15.
    Balkwill, F., & Mantovani, A. (2012). Cancer-related inflammation: Common themes and therapeutic opportunities. Seminars in Cancer Biology, 22, 33-40.
    Biegler, K., Chaoul, A., & Cohen, L. (2009). Cancer, cognitive impairment, and meditation. Acta Oncologica, 48, 18-26.
    Buffart, L. M., van Uffelen, J. G., Riphagen, I. I., Brug, J., van Mechelen, W., Brown, W. J., & Chinapaw, M. J. (2012). Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. Retrieved from
    Chandwani, K. D., Ryan, J. L., Peppone, L. J., Janelsins, M. M., Sprod, L. K., Devine, K., … Mustian, K. (2012). Cancer-related stress and complementary and alternative medicine: A review. Retrieved from
    Cole, S. (2013). Nervous system regulation of the cancer genome. Brain, Behavior, and Immunity, 30(Suppl.), S10-S18.
    Colotta, F., Allavena, P., Sica, A., Garlanda, C., & Mantovani, A. (2009). Cancer-related inflammation, the seventh hallmark of cancer: Links to genetic instability. Carcinogenesis, 30, 1073-1081.
    Doorenbos, A., Given, B., Given, C. W., Verbitsky, N., Cimprich, B., & McCorkle, R. (2006). Symptom limitations: Effects of a cognitive behavioral intervention randomized trial. Psycho-Oncology, 14, 574-584.
    Ernst, E. (2003). The current position of complementary/alternative medicine. European Journal of Cancer, 39, 2273-2277.
    Ernst, E. (2006). Herbal remedies for anxiety: A systematic review of controlled clinical trials. Phytomedicine, 13, 205-208.
    Faul, L. A., Jim, H. S., Minton, S., Fishman, M., Tanvetyanon, T., & Jacobsen, P. (2011). Relationship of exercise to quality of life in cancer patients beginning chemotherapy. Journal of Pain and Symptom Management, 41, 859-869.
    Fawzy, I., Kemeny, M., Fawzy, N., Elashoff, R., Morton, D., Cousins, N., & Fahey, J. (1990). A structured psychiatric intervention for cancer patients: Changes over time in immunological measures. Archives of General Psychiatry, 47, 729-735.
    Germano, G., Allavena, P., Mantovani, A. (2008). Cytokines as a key component of cancer-related inflammation. Cytokine, 43, 374-379. doi:10.1016/j.cyto.2008.07.014
    Glaser, R., & Kiecolt-Glaser, J. (2005). Stress-induced immune dysfunction: Implications for health. Nature Reviews. Cancer, 5, 243-251.
    Green, P., O'Connell, M., & Lutgendorf, S. (2013). Psychoneuroimmunology and cancer: A decade of discovery, paradigm shifts, and methodological innovations. Brain, Behavior, and Immunity, 30, S1-S9.
    Kang, D. H., Rice, M., Park, N., Turner-Henson, A., & Downs, C. (2010). Stress and inflammation: A biobehavioral approach for nursing research. Western Journal of Nursing Research, 32, 730-760.
    Kemeny, M., & Schedlowski, M. (2007). Understanding the interaction between psychosocial stress and immune-related diseases: A stepwise progression. Brain, Behavior, and Immunity, 21, 1009-1018. doi:10.1016/j.bbi.2007.07.010
    Kiecolt-Glaser, J. K., Bennett, J., Andridge, R., Peng, J., Shapiro, C., Malarkey, W., … Glaser, R. (2014). Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: A randomized controlled trial. Journal of Clinical Oncology, 32, 1040-1049.
    Kiecolt-Glaser, J. K., Christian, L., Preston, H., Houts, C., Malarkey, W., Emery, C., & Glaser, R. (2010). Stress, inflammation, and yoga practice. Psychosomatic Medicine, 72, 113-121.
    Kiecolt-Glaser, J. K., Preacher, K. J., MacCallum, R. C., Atkinson, C., Malarkey, W. B., & Glaser, R. (2003). Chronic stress and age-related increases in the pro-inflammatory cytokine IL-6. Proceedings of the National Academy of Sciences of the United States of America, 100, 9090-9095.
    Kundu, J. K., & Surh, Y. J. (2008). Inflammation: Gearing the journey to cancer. Mutation Research, 659, 15-30.
    Kundu, J. K. & Surh, Y. J. (2012). Emerging avenues linking inflammation and cancer. Free Radical Biological Medicine, 52, 2013-3037.
    Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York, NY: Springer.
    Lin, W., & Karin, M. (2007). A cytokine-mediated link between innate immunity, inflammation, and cancer. Journal of Clinical Investigation, 117, 1175-1183.
    Lust, J. A., Lacy, M. Q., Zeldenrust, S. R., Dispenzieri, A., Gertz, M. A., Witzig, T. E., … Donovan, K. A. (2009). Induction of a chronic disease state in patients with smoldering or indolent multiple myeloma by targeting interleukin 1{beta}-induced interleukin 6 production and the myeloma proliferative component. Mayo Clinic Proceedings, 84, 114-122. doi:10.4065/84.2.114
    Lutgendorf, S., & Sood, A. (2011). Biobehavioral factors and cancer progression: Physiological pathways and mechanisms. Psychosomatic Medicine, 73, 724-730.
    Lutgendorf, S., Sood, A., & Antoni, M. (2010). Host factors and cancer progression: Biobehavorial signaling pathways and interventions. Journal of Clinical Oncology, 28, 4094-4099.
    Mantovani, A., Allavena, P., Sica, A., & Balkwill, F. (2008). Cancer-related inflammation. Nature, 454, 436-444.
    McDonald, P., O'Connell, M., & Lutgendorf, S. (2013). Psychoneuroimmunology and cancer: A decade of discovery, paradigm shifts, and methodological innovations. Brain, Behavior, and Immunity, 30, S1-S9.
    McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Review, 87, 873-904.
    McGregor, B., & Antoni, M. (2009). Psychological intervention and health outcomes among women treated for breast cancer: A review of stress pathways and biological mediators. Brain, Behavior, and Immunity, 23, 159-166.
    Midtgaard, J., Rørth, M., Stelter, R., Tveteras, A., Andersen, C., Quist, M., … Adamsen, L. (2005). The impact of a multidimensional exercise program on self-reported anxiety and depression in cancer patients undergoing chemotherapy: A phase II study. Palliative and Supportive Care, 3, 197-208. doi:10.1017/S1478951505050327
    Mock, V., Dow, K., Meares, C. J., Grimm, P. M., Dienemann, J. A., Haisfield-Wolfe, M. E., … Gage, I. (1997). Effects of exercise on fatigue, physical function, and emotional distress during radiation therapy for breast cancer. Oncology Nursing Forum, 24, 991-1000.
    National Center for Complementary and Alternative Medicine. (2014). Complementary, alternative, or integrative health: What's in a name? Retrieved from
    Payne, J., Held, J., Thorpe, J., & Shaw, H. (2008). Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer. Oncology Nursing Forum, 35, 635-642.
    Powell, N. D., Tarr, A. J., & Sheridan, J. F. (2013). Psychosocial stress and inflammation in cancer. Brain, Behavior, and Immunity, 30, S41-S47. doi:10.1016/j.bbi.2012.06.015
    Reuter, S., Gupta, S. C., Chaturvedi, M. M., & Aggarwal, B. B. (2010). Oxidative stress, inflammation, and cancer: How are they linked? Free Radical Biological Medicine, 49, 1603-1616.
    Sherwood, P., Given, B., Given, C. W., Champion, V., Doorenbos, A., Azzouz, F., … Monahan, P. (2005). A cognitive behavioral intervention for symptom management in patients with advanced cancer. Oncology Nursing Forum, 32, 1190-1198. doi:10.1188/05. ONF.1190-1198
    Sood, A., Bhatty, R., Kamat, A., Landen, C., Han, L., Thaker, P., … Cole, S. (2006). Stress hormone-mediated invasion of ovarian cancer cells. Clinical Cancer Research, 12, 369-375.
    Spiegel, D., Bloom, J., Kraemar, H., & Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2, 888-891.
    Thaker, P., & Sood, A. (2008). Neuroendocrine influences on cancer biology. Seminars in Cancer Biology, 18, 164-170.
    Xing, M. (2012). Oxidative stress: A new risk factor for thyroid cancer. Endocrine Related Cancer, 19, C7-C11.
    Yadav, R. K., Magan, D., Mehta, N., Sharma, R., & Mahapatra, C. (2012). Efficacy of a short-term yoga-based lifestyle intervention in reducing stress and inflammation: Preliminary results. Journal of Alternative and Complementary Medicine, 18, 662-667. doi:10.1089/acm.2011.0265
    Yang, C. Y., Tsai, J. C., Huang, Y. C., & Lin, C. C. (2011). Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy. Journal of Advanced Nursing, 67, 158-168.