All Stressed Out

What effect does stress have on the healing process for survivors?

When Tracy Maxwell finished treatment for stage 2C ovarian cancer in 2006, she thought her stress level had subsided. Then she had two auto accidents in a month. “I had one fender bender the day I got my driver’s license at 16, and then never had an accident until I finished treatment,” says the 39-year-old Denver resident. “I think it was a wake-up call.”

Dealing with post-treatment stress means recognizing the potentially complex relationship between physical and psychological stress, understanding how it might affect your immune system, and, ultimately, your health, while absorbing the new information that stress can impact cancer survival. 

According to the National Cancer Institute, psychological stress combines an individual’s emotional and physiological reactions when confronting a situation where the demands may exceed the person’s ability to cope. Simply put, the body is constantly bombarded by “stressors” of its external environment. It responds by releasing stress hormones, such as epinephrine (adrenaline) and cortisol (hydrocortisone) to help the body react to the stressful situation with speed and strength, while at the same time increasing blood pressure, heart rate, and blood sugar levels.

While small amounts of stress are seen as beneficial, studies indicate that chronic high levels of stress could be harmful and increase the risk of obesity, heart disease, and depression, among other illnesses. Stress beyond an individual’s ability to cope may also lead to unhealthy coping behaviors, some of which may affect cancer risk, such as overeating, smoking, or abusing drugs or alcohol. And newer studies indicate stress creates a cascade effect that promotes an inflammatory response in the body, which leads to a friendly environment for cancer. 

Michael Burke, MD, clinical director of psychiatric oncology at the Emory Winship Cancer Institute in Atlanta, explains how stress builds, beginning with the initial alarm stage, in which the body responds with stress hormones for a fight-or-flight response. Alarm is followed by a resistance phase, when the body attempts to cope with the demands of an ongoing stressor. Finally there is an exhaustion phase, when the body has been unable to adapt to the stressor. 

Burke explains that it is during the exhaustion phase that negative biological and psychological effects occur—such as Maxwell’s two car accidents, the ­inability to get along with family and friends, or unhealthy coping behaviors, such as overeating or drinking heavily.

According to the National Cancer Institute, studies conducted over the past 30 years examining the relationship between psychological factors, including stress, and the risk of developing cancer have produced conflicting results, with no direct cause-and-effect relationship  proven. Still, some studies have indicated an indirect relationship between stress and certain types of virus-related tumors. Evidence from both animal and human studies suggests that chronic stress weakens a person’s immune system, which in turn may affect the incidence of virus-associated cancers, such as Kaposi sarcoma and some lymphomas. 

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