High levels of stress and low social support may affect the accelerated progression of cancer

Cancer has become a chronic disease that, culturally and historically, is related to pain and death. Because of this and how complex the disease and the treatment is, the diagnostic stage causes a big impact on the patient and his/her family to an emotional level. It often takes time for the patient to assimilate and accept the situation he/her is going through and undergo treatment.

During the course of this oncological illness, the patients experience a grieving process, that is, a process of adaptation on a series of losses, not only regarding health but also in loss of stability, security, change of routine and daily life, a loos of the role that used to exist within the family, work or social place, loss of control, amongst others. It has been observed that loss of control can be one of the most destabilizing things for a human being.

During the mid-seventies, there is a formal beginning for a very wide research field regarding how oncological patients react. These researches include the adaptation to the illness, to medical interventions, psychological interventions and the adaptation processes of the patient, the research of neuroendocrine and immunological variables that measure the processes of illness manifestation, palliative care, psychopharmacological problems and ethical dilemmas.

Said research field is known as psycho-oncology, born from the falling of the barrier existing between the medic – patient treatment to reveal diagnosis, it made possible to speak with patients about treatment and the implication of cancer in their lives. According to MD Holland, considered the founder of psycho-oncology, it is a subspecialty of oncology in charge of attending the emotional responses of patients with cancer, their families and the health personnel taking care of patients. And as well it involves the study of the factors that influence morbidity and mortality of this illness, that is, the psychological, behavioral, and social factors.

Doctors have observed for a long time that the psychosocial conditions of patients seem to affect the progression of cancer in some cases. Epidemiological studies support this observation on documenting the accelerated progression of many types of cancer between individuals with high levels of stress or low social support.

During the last decade, a growing laboratory basic research group has identified physiological routes that can mediate said effects through the biological modulation of the tumor progression and metastasis. Studies have identified the specific psychosocial effects and factors of resilience associated with the differential progression of disease in cancer.  A strategy of social genomics research has started to be implemented, this to understand how this relationships can occur at a cellular or molecular level on the tumor microenvironment (normal cells, molecules, blood vessels that surround and feed the tumor).

Initial studies examined the profiles of genic expression of tumor tissue resected during surgery, and found different specific profiles of transcriptome alteration that could contribute to the differential progression of the disease. The studies of carcinoma ovary tissue found a higher expression of genes involved on inflammation, the angiogenesis. Similar results have appeared on breast cancer analysis.

Social genomic research on resilience factors suggests that promoting a personally signifying life with a purpose (like spiritual characteristics) can have healthier molecular effects than the optimization of the experience of hedonic well-being, like affection or satisfaction with life. There is still a lot to discover on the reach and the mechanisms of said effects but it is suggested to help patients with cancer to clarify their values and strengthen their commitment with a substantial personal impact that can help to have a better personal adaptation on cancer survival.

Reviewers: Brenda Giselle Alvarez Rodriguez (Public Health Research Unit), and Cassandra Saldaña Pineda (Knowledge Management Unit).

Sources:

• Article: “Psycho-oncology: a psychosocial support and intervention model”. Revista Médica Clínica Las Condes 2013;24:677-84
• Article: “New challenges in psycho‐oncology: Neural regulation of the cancer genome”. Psycho‐ 2018;1–5.