Lifelong stress may be associated with higher risk of mortality caused by cancer

December 2022 Science Nalinee Pandey

A real person, real life senior adult man hospital medical clinic outpatient colorectal cancer patient is sleeping in a reclining chair while intravenous IV drip chemotherapy medicine is administered through a surgically implanted subcutaneous chemo access port embedded into his upper chest. Chemotherapy medicine - from the bags hanging on the medical equipment "tree" up above - drips down through a long, thin plastic tube attached with connectors, caps and a big yellow butterfly clamp to the needle syringe temporarily poked into and through the patient's chest port. Part of a "Daily Living with Cancer" image series - submitted for brief #775310942.

Recent findings published in the journal SSM Population Health suggest that lifelong stress could increase cancer mortality risk, especially among the younger population.

It is a well-known fact that stress can have a negative effect on our health in general. In particular, chronic stress can cause systemic inflammation. But whether stress can have long-term effects on death due to cancer is still unknown. Therefore, Moore and colleagues have investigated the possible association of allostatic load, a measure of lifelong stress, with cancer deaths among individuals from diverse ethnic and racial backgrounds.

Study Design and Main Findings

The retrospective analysis included data from 41,218 individuals included in the U.S. National Health and Nutrition Examination Survey between 1988 and 2019. Cox proportional hazards models were used to estimate the subdistribution HRs (sHRs) of cancer death between groups of individuals with low or high allostatic load. The data comprised approximately equal numbers of patients with low (n=21,504) and high (n=19,714) allostatic loads. Patients with high versus low allostatic load tended to be older (mean age, 53.2 years vs 39.4 years), black (12.9% vs 8.4%), diagnosed with congestive heart failure (3.9% vs 0.8%) or heart attack (5.6% vs 1.7%), and with a history of cancer (11.3% vs 5.7%).

The analysis of the patient data revealed that individuals with high allostatic load (14%) had an increased risk of cancer-related mortality (sHR = 1.14; 95% CI, 1.04-1.26) than those with low allostatic load. Further, between ethnicities, white individuals had an 18% increase in risk (sHR = 1.18; 95% CI, 1.03-1.34), whereas a nonsignificant association of 8% and 3% increased risk was seen among Black and Hispanic individuals. Notably, Black, white patients and Hispanic below 40 years of age with high allostatic load had a 106%, 95% and 36% increased risk of death due to cancer, respectively.

Conclusion

The findings of the study signal the need for multi-level strategies for managing stress. Furthermore, the effect of high allostatic load on cancer progression over time needs to be further studied.

Reference

Moore JX, et al. SSM Popul Health. 2022;doi:10.1016/j.ssmph.2022.101185.