Being in the oncologist’s office is always stressful. It appears at the time of diagnosis, increases at each stage of treatment, and often does not resolve even after treatment has officially ended. It involves making treatment decisions, waiting for test results, fear of recurrence, and changes in daily functioning. Research shows that chronic stress can trigger biological processes that accelerate disease progression and weaken the body’s defenses.
This perspective is presented in a systematic review prepared by researchers from the Wroclaw Medical University and published in 2026. International Journal of Molecular Science. The authors analyzed data on four cancers: breast cancer, prostate cancer, pancreatic cancer, and ovarian cancer, and organized them based on 5-year survival rates.
What exactly is chronic stress?
From a biological perspective, chronic stress places long-term strain on the body’s ability to adapt. This is not a one-time reaction to a difficult event, but a condition in which the systems responsible for responding to threats remain active for weeks or months.
In oncology, stress is multifaceted. It includes social, occupational, familial, and existential factors as well as anxiety and sadness. For many patients, it means having to redefine their life plans, social roles, and sense of control over their bodies.
The authors of this review describe the mechanisms linking chronic stress and the course of cancer in a way that can be categorized into three related stages.
- hormone alarm
Chronic stress causes sustained activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system. In practice, this means that cortisol, adrenaline, and noradrenaline levels increase over time.
Katarzyna Helbetko, co-author of this review, emphasizes: -The body functions as if it is constantly in danger mode. This is associated with increased inflammation and immunosuppression, which can accelerate tumor progression and weaken response to treatment.
- immunity and inflammation
Stress hormones affect the immune system. Long-term exposure to cortisol and catecholamines can weaken immune surveillance and tip the balance toward chronic, low-grade inflammation. This is an environment in which cancer cells can more easily survive, proliferate, and evade control mechanisms.
- tumor environment
At the tissue level, chronic stress can affect processes related to angiogenesis, cancer cell migration, and treatment resistance.
However, the authors consistently point out important caveats. Although these mechanisms are biologically consistent with current knowledge, it is very difficult to separate the effects of stress from disease progression, treatment intensity, and other clinical factors in clinical trials.
Not all cancers are the same
One of the key conclusions of this review is that chronic stress does not affect all cancers equally. Its biological and clinical significance depends on both the type of disease and its prognosis.
In cancers with high survival rates, such as breast and prostate cancer, stress most often takes the form of chronic anxiety. Patients live with this disease for a long time, battling fear of recurrence, side effects of treatment, and permanent changes in quality of life. In this context, the biological role of adrenergic and glucocorticoid signaling has come into focus, and preclinical studies have shown that it is associated, among other things, with metastasis and response to therapy. This does not mean that stress “interferes with treatment,” but rather that in some patients stress may be an additional biological factor contributing to the course of the disease.
A different picture appears for cancers with a poor prognosis, such as pancreatic and ovarian cancers. Psychological distress and depression are more common and usually more severe in this group. Importantly, psychological symptoms may precede a cancer diagnosis, suggesting the involvement of biological mechanisms rather than simply an emotional response to the diagnosis. At the biological level, inflammatory and cytokine mechanisms are dominant, including increased IL-6 levels and significant systemic stress.
Psychological distress is not just an emotion, but a factor that contributes to the physiological overload of the body and can reduce the reserves necessary for the therapeutic process. ”
Katarzyna Herbetko, Faculty of Medicine, Wrocław Medical University
Psychotherapy – more than just a conversation
The authors of this review emphasize that psychotherapy in oncology is more than just emotional support. Data shows that psychological interventions can:
- Reduce anxiety and depression,
- improve quality of life,
- Affect stress and inflammatory markers such as cortisol levels and selected cytokines.
At the same time, researchers remain cautious in their interpretations.
“There is no simple correlation that psychotherapy = longer survival. We are seeing real, measurable biological changes, but current knowledge does not allow us to draw clear conclusions regarding mortality,” added Katarzyna Helbetko.
It should be noted that the effects of psychotherapy may weaken after its completion, indicating the need for long-term rather than temporary support.
Conclusion and recommendations
The authors clearly point out the limitations of the available data.
- disparate methods of measuring stress,
- lack of meta-analyses that allow precise quantitative conclusions;
- It is difficult to distinguish between stress as a biological factor and stress as a result of serious illness or treatment.
The overarching message of this review is clear. Chronic stress is not the patient’s fault. Rather, it is a factor related to measurable biological processes that can and should be addressed clinically, such as pain, malnutrition, and sleep disturbances.
The authors suggest:
- Systematic integration of psycho-oncology into standard treatment;
- routine distress screening and prompt assistance;
- support for partners and carers;
- Development of digital interventions (e-health) and strategies to maintain treatment effectiveness.
As Katarzyna Herbetko summarized, “Psycho-oncology cannot be an afterthought. Chronic stress should be treated as a modifiable risk factor in oncology and analyzed in the context of complex biological, psychological and environmental interactions.”
sauce:
Wroclaw Medical University
Reference magazines:
Herbetko, K., et al (2026) The impact of chronic stress on treatment outcomes in cancer patients with different survival rates: a systematic review. International Journal of Molecular Science. DOI: 10.3390/ijms27020686. https://www.mdpi.com/1422-0067/27/2/686.
