Biobehavioral Pathways and Cancer Progression: Insights for Improving Well-Being and Cancer Outcomes

Abstract

The relationship between psychosocial factors and cancer has intrigued people for centuries. In the last several decades there has been an expansion of mechanistic research that has revealed insights regarding how stress activates neuroendocrine stress-response systems to impact cancer progression. Here, we review emerging mechanistic findings on key pathways implicated in the effect of stress on cancer progression, including the cellular immune response, inflammation, angiogenesis, and metastasis, with a primary focus on the mediating role of the sympathetic nervous system. We discuss converging findings from preclinical and clinical cancer research that describe these pathways and research that reveals how these stress pathways may be targeted via pharmacological and mind-body based interventions. While further research is required, the body of work reviewed here highlights the need for and feasibility of an integrated approach to target stress pathways in cancer patients to achieve comprehensive cancer treatment.

Keywords: beta-adrenergic; biobehavioral; cancer progression; cortisol; inflammation; mind-body interventions; stress; sympathetic nervous system.

Figure 1.

Effects of stress response processes on evaluation of level of threat, interaction of sympathetic nervous system (SNS), and hypothalamic-pituitary-adrenal (HPA) axis with tumor cells and cells in the tumor microenvironment, and ultimate effects on tumor progression and the clinical course of cancer. Source: Figure originally published in Green McDonald P, O’Connell M, Lutgendorf SK. Psychoneuroimmunology and cancer: a decade of discovery, paradigm shifts, and methodological innovations. Brain Behav Immun. 2013;30:S1-S9. doi:10.1016/j.bbi.2013.01.003.