Tuesday, 29 January 2013

More On Stress and Cancer

A new open access research paper, 'Behavioural Stress Accelerates Prostate Cancer Development in Mice' (http://www.jci.org/articles/view/63324), adds more detail to the emerging picture of the relationship between stress and cancer. In this case the research team used mouse models to investigate the effect of stress on the development and progression of prostate cancer. And, as expected, those mice subjected to a stressful environment had greater incidence of cancer and higher rates of disease progression. And, just as importantly, some of the ill-effects of a stressful environment could be prevented through the use of drugs that interfere with the stress response to raised adrenalin and noradrenaline (i.e. like beta blockers).

From a science point of view this paper uncovers some of the molecular mechanisms at play here, which further advances our understanding of the relationship between psycho-social stresses, the resulting hormone stress response and the process of cancer initiation and progression.

However, it's the human angle that is of direct interest to me, (and to most readers of this article I would guess). What this new paper does is point out the horrible vicious circle that is at play here. As we know a cancer diagnosis is an incredibly frightening and stressful experience. It shakes your world up completely. The body responds to this stress by releasing adrenaline and other stress hormones. These can drive the cancer forward, causing even more stress as the disease progresses. It's not just the bad news. Cancer treatments are stressful too. Physically they are hard to take - there are side effects of drugs, radiotherapy and surgery. But there's also the stress induced by the whole process - the endless waiting, the delays, the uncertainty, the feeling of being disempowered.

Unless there are some convincing clinical trials soon, it's unlikely that the average oncologist is going to want to prescribe beta blockers to stressed cancer patients. While there's evidence that people on beta blockers have lower cancer incidence than the general population, and increasing laboratory evidence that beta blockers work in the test tube and in animals, it's unlikely to be enough to convince an oncologist that this is something they should act on. The gold standard is the randomised blinded clinical trial, and they're some way of yet when it comes to beta blockers as a complement to other cancer treatments. We're in exactly the same boat as we're in for metformin, low dose naltrexone and aspirin - all are cheap, relatively non-toxic, widely used and have very strong evidence of anti-cancer effect.

But that doesn't mean people should sit back and wait.

There are numerous ways that people can take steps to reduce stress levels. There are proven methods that have been shown to work in cancer patients, including mindfulness meditation, yoga, cognitive behavioural therapy, massage, exercise and more. Many hospitals now provide access to alternative treatments like aromatherapy, as well as access to counsellors, meditation classes and so on. There is also strong evidence of the positive effects of melatonin and high dose omega 3s or flax seed oil is also beneficial.

There are two reasons for taking advantage of these interventions. The first and most obvious is that these steps act to reduce stress directly. However, there's a second and more subtle reason. Taking active steps, under your own steam, is important because it's about taking back some sense of control. And this too will have a positive effect on stress. So rather than that vicious circle of stress causing disease progression causing more stress, you have the virtuous circle of anti-stress interventions causing less stress. And let's face it, how many people don't need to reduce stress, let alone people dealing with cancer.

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