April 4, 2012

How Stress may Impact Recovery

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Joseph V. Madia, MD By:

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Stress management and cancer response link examined

In our modern world, stress can become a way of life. The American Institute of Stress manages a list of over 50 common symptoms of stress, including jaw clenching, insomnia, chest pain, social withdrawal and hives. Everyone has experienced how stress and its symptoms can interfere during a hectic day.

What’s harder to recognize is how continued exposure to stress can affect long-term health, especially in bodies already coping with a chronic  disease.

New research sheds light on possible ties between cancer development and stress management, providing hope both for patients playing an active role in their own recovery and for possible new cancer-fighting drugs.

So What Exactly is Stress?

Stress is not always a bad thing. It can help you hurry to meet that deadline at work or act quickly to escape from danger. However, with today’s fast-paced lifestyles, stress can become a constant state, causing a number of physical and emotional reactions in the body.

When a person comes across a force (external or internal), that is perceived as a threat, the body activates the flight-or-fight response system, rallying all resources to face the problem. The brain’s hypothalamus is stimulated, sending out endocrine and nervous system signals that cause a rush of hormones (like adrenaline and cortisol) to be released by the adrenal glands.

These hormones increase heart rate and blood pressure, prepare muscles and tissues, increase energy and elevate levels of sugar in the bloodstream. They also slow down peripheral body functions, like digestion, reproduction, growth and immunity, in order to reserve energy for functions essential to the fight-or-flight situation at hand.

Usually, the hormone levels decrease as the threat passes and your body resumes its normal processes. But when stress is a constant, the fight-or-flight system remains activated, potentially causing issues throughout the body. According to the Mayo Clinic, long-term stress increases your risk of obesity, depression, heart disease, worsening of skin conditions and digestive problems, among others.

In short, this stress-response system is a godsend when you meet a wild animal in the woods, but it can cause harm when stress becomes a part of day-to-day life. An example would be when a patient is coping with their primary cancer treatment and the resulting continual stress.

New Research Explores Stress and Genetic Expression in Cancer Patients

A recent University of Miami study showed correlation between the management of stress and a decrease in tumor-promoting processes in breast cancer patients. The study, led by Michael H. Antoni, Ph.D, placed breast cancer patients into either a control group or a Cognitive-Behavioral Stress Management (CBSM) group in the weeks following their initial surgery.

In the results, not only did the women armed with stress-control tactics seem to handle the emotional and mental stress of dealing with cancer better than the control group, but they seemed to handle the physical stress of the surgery better down to the level of their individual genes.

According to Antoni, after both six month and 12-month follow ups with 79 subjects, the women in the CBSM group displayed “better psychological adaptation to the whole process of going through treatment for breast cancer and there were physiological changes that indicated that the women were recovering better.”

In these women, genes which activate molecules related to cancer growth and progression were down-regulated while genes which activate molecules related to a robust immune system were up-regulated. This resulted in their bodies producing less harmful material, like pro-inflammatory cytokines, and more beneficial material, like type I interferon.

"The results suggest that the stress management intervention mitigates the influence of the stress of cancer treatment and promotes recovery over the first year," said Antoni.

While this study is not conclusive, it does provide evidence that stress and our genes’ expressions could be linked. The University of Miami team will continue to watch participants’ health to see how these results develop in the long term.

Looking Forward - Developing New Treatments

A planned study at Tel Aviv University aims to apply results from research like the University of Miami’s CBSM work to pharmacological treatment.

"Given our current understanding of how psychological and physiological stress help tumor cells to spread, we can now intervene in a simple and effective manner," said Shamgar Ben-Eliyahu, Ph.D, who is leading the study with Oded Zmora, M.D.

According to Ben-Eliyahu, tumors synchronize the timing of their growth and metastasis with vulnerabilities in the body - vulnerabilities like a weakened immune system due to the physical and emotional stress of cancer. He hopes to address this issue in a new way by treating the patients with common stress medication in an attempt to slow down the spread of cancer.

The study, which is currently recruiting 400 cancer patients, will administer a beta-adrenergic antagonist and a COX2 inhibitor (two drugs traditionally used to treat hypertension, anxiety, inflammatory responses and high stress levels) to patients before, during and after surgery to examine the effects on recovery.

The Tel Aviv and The University of Miami studies, and others like them, will continue to be examined closely to see how they develop over time. In the meantime, it is possible to take an active role now in personal stress management.

To control the stress surrounding cancer treatment, participants in the CBSM group at the University of Miami focused on fostering a positive attitude towards life through deep breathing, imagery and cognitive behavior therapy.

The Mayo Clinic recommends first identifying the major stressors in your life so that you can more consciously approach them. Ensuring a healthy diet and active lifestyle, maintaining supportive friendships, practicing relaxation techniques and approaching life with a sense of humor can all be effective ways to manage stress. 

Conditions: 
Stress Mental Health

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
March 29, 2012

Last Updated:
April 24, 2012