How can Managing Stress help you? What the research says

Identifying, reducing, or removing the stressors in your life is a critical dimension of healing with cancer. So is managing your response to the stressors you can’t remove.

How can Managing Stress help you? What the research says

How does Managing Stress impact your cancer outcomes, affect your quality of life, or impact your body terrain? We present the evidence.

We strongly emphasize that Managing Stress alone will not prevent, cure, control cancer or prevent recurrence. Like every therapy or approach included on this website, Managing Stress is one component of an individualized integrative plan rather than a stand-alone therapy.

Find guidance and therapies about how to manage your stress response on our main Managing Stress page ›

We summarize the clinical evidence for each medical benefit here. We begin with our assessment of the strength of evidence within each category, followed by a brief summary of individual studies or reviews of several studies. In assessing the strength of evidence, we consider the study design, number of participants, and the size of the treatment effect (how much outcomes changed with treatment).

To see more details, click the plus sign to the right of any section.

Our assessments of evidence for each medical benefit fall into one of these categories:

Strong evidence: consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results
Good evidence: significant effects in one large or several mid-sized and well-designed clinical studies ( randomized controlled trialsa study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
Modest evidence: significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies), or several small studies aggregated into a meta-analysis
Preliminary evidence: significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect
Weak evidence: one or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects
Insufficient evidence: preclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example)

Learn more about how we research and rate therapies and practices in How We Rate Therapies ›

Improving treatment outcomes

Is Managing Stress linked to improved survival? Is it linked to less cancer growth or metastasis? Does it enhance the anticancer action of other treatments or therapies? We present the evidence.

Cancer as a whole

Breast cancer

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of substantially better survival among people with breast cancer with lower markers of stress

Preliminary evidence of lower risk of breast cancer relapse among people with lower markers of stress

Kidney cancer

Preliminary evidence of moderately better survival among people with kidney cancer with lower markers of stress

Preliminary evidence of lower risk of kidney cancer relapse among people with lower markers of stress

Lung cancer

Preliminary evidence of moderately better survival among people with lung cancer with lower markers of stress or distress

Melanoma and other skin cancers

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of higher mortality among people with melanoma experiencing bereavement

Managing Stress in combination with other practices

Preliminary evidence of lower prostate-specific antigen (PSA) levels—a marker of potential cancer activity—among men participating in a lifestyle intervention including a health-promoting diet, physical activity, group support, and stress management

Optimizing your body terrain

How does Managing Stress promote an environment within your body that is less supportive of cancer development, growth or spread? We present the evidence.

See Optimizing Your Body Terrain ›

Find medical professionals who specialize in managing body terrain factors: Finding Integrative Oncologists and Other Practitioners ›

High blood sugar and insulin resistance

Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of higher blood glucose levels among people reporting higher stress

Hormone imbalance

Changes in hormone levels seen in the studies here may not be beneficial in every situation. Your oncology team needs to determine whether any changes would be favorable for your condition.

Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of higher levels of ghrelin (the “hunger hormone”) among people put in acute stressful situations

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) that a prolonged or exaggerated stress response may perpetuate cortisol dysfunction

Immune function

Increased immune system activation is not always beneficial, so your oncology team needs to determine whether immune activation would be favorable in your situation.

Your neutrophil to lymphocyte ratio (NLR) is an indicator of stress.

Inflammation

Modest evidence that a prolonged or exaggerated stress response may perpetuate widespread inflammation

Managing side effects and promoting wellness

Is Managing Stress linked to fewer or less severe side effects or symptoms? Is it linked to less toxicity from cancer treatment? Does it support your quality of life or promote general well-being? We present the evidence.

Anxiety

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of lower anxiety and distressemotional, social, spiritual, or physical pain or suffering that may cause a person to feel sad, afraid, depressed, anxious, or lonely; people in distress may also feel that they are not able to manage or cope with changes caused by normal life activities or by having a disease, such as cancer among people with better acceptance of cancer

Depression

Good evidence of lower depression among people with better acceptance of cancer

Quality of life and function

Good evidence of better quality of life among people with some better markers of stress management, including self-efficacybelief in your ability to control your own behavior, emotions, and motivations for coping with cancer and lower fear and uncertainty regarding cancer recurrence

Substantially lower distressemotional, social, spiritual, or physical pain or suffering that may cause a person to feel sad, afraid, depressed, anxious, or lonely; people in distress may also feel that they are not able to manage or cope with changes caused by normal life activities or by having a disease, such as cancer and better quality of life among people with higher scores for self-efficacy for coping with cancer compared to others in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 180 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies²²Chirico A, Lucidi F, Merluzzi T, Alivernini F, Laurentiis M, Botti G, Giordano A. A meta-analytic review of the relationship of cancer coping self-efficacy with distress and quality of life. Oncotarget. 2017 May 30;8(22):36800-36811.
Lower quality of life among people with blood cancers with higher fear and uncertainty regarding cancer recurrence (Damocles syndrome) compared to others in a review²³Alabdaljabar MS, Muhsen IN, Knight JM, Syrjala KL, Hashmi SK. Free of malignancy but not of fears: a closer look at Damocles syndrome in survivors of hematologic malignancies. Blood Rev. 2021 Jul;48:100783.
Higher subjective well-being among women recently completing breast cancer treatment who had lower levels of stress in a mid-sized observational study²⁴McDonough MH, Sabiston CM, Wrosch C. Predicting changes in posttraumatic growth and subjective well-being among breast cancer survivors: the role of social support and stress. Psycho-Oncology. 2014 Jan;23(1):114-20.

Pain

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) that a prolonged or exaggerated stress response may perpetuate pain

Modest evidence of a link between distress or stress and pain among people with cancer

Modest evidence that a prolonged or exaggerated stress response may perpetuate pain

A prolonged or exaggerated stress response may perpetuate pain in a review of evidence.²⁵Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Physical Therapy. 2014 Dec;94(12):1816-25.

Modest evidence of a link between distress or stress and pain among people with cancer

Link between increased pain and increased distress among people with cancer in 14 of 19 studies in a review²⁶Zaza C, Baine N. Cancer pain and psychosocial factors: a critical review of the literature. Journal of Pain and Symptom Management. 2002 Nov;24(5):526-42.
More psychological stress among people with cancer experiencing cancer-related breakthrough pain compared to those without breakthrough pain in a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study²⁷Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999 May;81(1-2):129-34.
Higher prevalence of emotional distress among people with cancer reporting high pain levels compared to low pain levels in a small observational study²⁸Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer. 1994 Nov 1;74(9):2570-8.
Greater total life stress among people with metastatic and/or recurrent breast cancer experiencing higher pain intensity compared to lower intensity in a mid-sized observational study²⁹Koopman C, Hermanson K, Diamond S, Angell K, Spiegel D. Social support, life stress, pain and emotional adjustment to advanced breast cancer. Psycho-Oncology. 1998 Mar-Apr;7(2):101-11.

Side effects not specific to people with cancer

Good evidence of higher depression, higher pain and lower pain self-efficacy, higher disability, lower function, and higher sleep disturbance among people with higher levels of stress

Modest evidence of moderately higher risk of cognitive impairment among adults aged 45 and older with elevated levels of perceived stress

Higher depression, higher pain and lower pain self-efficacy, higher disability and lower function, and higher sleep disturbance among military veterans with post-traumatic stress disorder (PTSD) and pain compared to veterans without PTSD in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 20 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies³⁰Benedict TM, Keenan PG, Nitz AJ, Moeller-Bertram T. Post-traumatic stress disorder symptoms contribute to worse pain and health outcomes in veterans with PTSD compared to those without: a systematic review with meta-analysis. Military Medicine. 2020 Sep 18;185(9-10):e1481-e1491.
Poorer sleep quality and time among people without a clinical mental health diagnosis with higher levels of worry and ruminationcontinuously returning to the same thoughts, which tend to be sad or dark compared to others in a meta-analysis of 55 observational studies³¹Clancy F, Prestwich A, Caperon L, Tsipa A, O’Connor DB. The association between worry and rumination with sleep in non-clinical populations: a systematic review and meta-analysis. Health Psychology Review. 2020 Dec;14(4):427-448.
Higher risk of insomnia among active-duty military personnel or veterans with PTSD compared to those without PTSD in a very large meta-analysis of 27 observational studies³²Huang Y, Xu J et al. The risk factors for insomnia and sleep-disordered breathing in military communities: a meta-analysis. PLoS One. 2021 May 6;16(5):e0250779.
Higher likelihood of insomnia among people with higher levels of stress hormones in a review³³Nicolaides NC, Vgontzas AN et al, editors. HPA axis and sleep. In Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–.
37% higher risk of cognitive impairment among adults aged 45 and older with elevated levels of perceived stress compared to low levels in a very large observational study³⁴Kulshreshtha A, Alonso A et al. Association of stress with cognitive function among older Black and White US adults. JAMA Network Open. 2023 Mar 1;6(3):e231860.

Reducing cancer risk

Is Managing Stress linked to lower risks of developing cancer or of recurrence? We present the evidence.

Cancer as a whole

Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of cancer as a whole among people with better stress-management skills or less distressemotional, social, spiritual, or physical pain or suffering that may cause a person to feel sad, afraid, depressed, anxious, or lonely; people in distress may also feel that they are not able to manage or cope with changes caused by normal life activities or by having a disease, such as cancer

Good evidence of higher risk of cancer mortality, especially people younger than 40, among people with a measure of cumulative stress

14% higher risk of cancer mortality overall, and 80% higher for people younger than 40, among people with a measure of cumulative stress (high allostatic load) compared to other people in a very large observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study³⁵Moore JX, Andrzejak SE, Bevel MS, Jones SR, Tingen MS. Exploring racial disparities on the association between allostatic load and cancer mortality: a retrospective cohort analysis of NHANES, 1988 through 2019. SSM—Population Health. 2022 Jul 31;19:101185.

Good evidence of lower risk of cancer as a whole among people with better stress-management skills

Higher risk of cancer among initially healthy people with stress-related psychosocial factors such as stress-prone personality, unfavorable coping styles, negative emotional responses, or poor quality of life, but not stressful life experiences, compared to others in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 165 observational studies;³⁶Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nature Clinical Practice. Oncology. 2008 Aug;5(8):466-75. our note: this is good evidence that the presence of stressful situations is not the problem, but that your responses to stress are what can affect your health—you have the potential to change your responses even if you cannot change the stressful situations in your life
32% higher risk of cancer mortality within 9.5 years, and 45% higher risk for cancers not related to tobacco smoking, among people without cancer at baseline with the most distress compared to the least distress in a very large pooled analysis of 16 studies³⁷Batty GD, Russ TC, Stamatakis E, Kivimäki M. Psychological distress in relation to site specific cancer mortality: pooling of unpublished data from 16 prospective cohort studies. BMJ. 2017 Jan 25;356:j108.

Breast cancer

Weakone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) and conflicting evidence of a slightly lower risk of breast cancer among people with less stress

Slightly higher risk of breast cancer among people with a history of stressful life events in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 11 observational studies³⁸Bahri N, Fathi Najafi T, Homaei Shandiz F, Tohidinik HR, Khajavi A. The relation between stressful life events and breast cancer: a systematic review and meta-analysis of cohort studies. Breast Cancer Research and Treatment. 2019 Jul;176(1):53-61.
A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) toward higher risk of breast cancer among women with higher intensity/frequency of stress compared to lower levels, but no evidence of an effect from widowhood or divorce, in a meta-analysis of 8 observational studies³⁹Santos MC, Horta BL, Amaral JJ et al. Association between stress and breast cancer in women: a meta-analysis. Cadenos de Saude Publica. 2009;25 Suppl 3:S453-63.
No evidence of an effect on risk of breast cancer among people with work stress compared to no work stress in a very large meta-analysis of 9 observational studies⁴⁰Yang T, Qiao Y et al. Work stress and the risk of cancer: a meta-analysis of observational studies. International Journal of Cancer. 2019 May 15;144(10):2390-2400.
No evidence of an effect on risk of breast cancer during 15 years among people with more chronic stressors compared to few stressors in a large observational study⁴¹Butow P, Price M et al; kConFab investigators; kConFab Clinical Follow-Up investigators; kConFab psychosocial investigators. Does stress increase risk of breast cancer? A 15-year prospective study. Psycho-Oncology. 2018 Aug;27(8):1908-1914.
Increased risk of breast cancer among women who had experienced loss of their father during childhood or a serious stressor within the last five years in a mid-sized observational study⁴²Yıldırım NK, Özkan M et al. Possible role of stress, coping strategies, and life style in the development of breast cancer. International Journal of Psychiatry Medicine. 2018 May;53(3):207-220.

Colorectal cancer

Good evidence of lower risk of colorectal cancer among people with less stress or lower levels of distress

Gastrointestinal cancer

Good evidence of lower esophageal cancer mortality among people with less stress or lower levels of distress

Leukemia

Good evidence of lower risk of leukemia among people with lower levels of distress

Lung cancer

Good evidence of lower risk of lung cancer among people with less work stress

Melanoma and other skin cancers

Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of melanoma within 5 years among people experiencing partner bereavement

Ovarian cancer

Modest evidence of higher risk of ovarian cancer among people with high posttraumatic stress disorder (PTSD) symptoms

No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on risk of ovarian cancer among people with work stress in a combined analysis of studies

Pancreatic cancer

Good evidence of lower risk of pancreatic cancer among people with lower levels of distress

Prostate cancer

Good evidence of lower risk of prostate cancer among people with lower levels of distress

No evidence of an increased risk of prostate cancer among people with work stress in a combined analysis of studies

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Last update: March 7, 2025

CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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How can Managing Stress help you? What the research says

Improving treatment outcomes

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Managing side effects and promoting wellness

Reducing cancer risk

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Jane Liaw, MPH

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References
1, 2, 36	Chida Y, Hamer M, Wardle J, Steptoe A. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nature Clinical Practice. Oncology. 2008 Aug;5(8):466-75.
3	Mathew A, Doorenbos AZ et al. Allostatic load in cancer: a systematic review and mini meta-analysis. Biological Research for Nursing. 2021 Jul;23(3):341-361.
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23	Alabdaljabar MS, Muhsen IN, Knight JM, Syrjala KL, Hashmi SK. Free of malignancy but not of fears: a closer look at Damocles syndrome in survivors of hematologic malignancies. Blood Rev. 2021 Jul;48:100783.
24	McDonough MH, Sabiston CM, Wrosch C. Predicting changes in posttraumatic growth and subjective well-being among breast cancer survivors: the role of social support and stress. Psycho-Oncology. 2014 Jan;23(1):114-20.
26	Zaza C, Baine N. Cancer pain and psychosocial factors: a critical review of the literature. Journal of Pain and Symptom Management. 2002 Nov;24(5):526-42.
27	Portenoy RK, Payne D, Jacobsen P. Breakthrough pain: characteristics and impact in patients with cancer pain. Pain. 1999 May;81(1-2):129-34.
28	Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer. 1994 Nov 1;74(9):2570-8.
29	Koopman C, Hermanson K, Diamond S, Angell K, Spiegel D. Social support, life stress, pain and emotional adjustment to advanced breast cancer. Psycho-Oncology. 1998 Mar-Apr;7(2):101-11.
30	Benedict TM, Keenan PG, Nitz AJ, Moeller-Bertram T. Post-traumatic stress disorder symptoms contribute to worse pain and health outcomes in veterans with PTSD compared to those without: a systematic review with meta-analysis. Military Medicine. 2020 Sep 18;185(9-10):e1481-e1491.
31	Clancy F, Prestwich A, Caperon L, Tsipa A, O’Connor DB. The association between worry and rumination with sleep in non-clinical populations: a systematic review and meta-analysis. Health Psychology Review. 2020 Dec;14(4):427-448.
32	Huang Y, Xu J et al. The risk factors for insomnia and sleep-disordered breathing in military communities: a meta-analysis. PLoS One. 2021 May 6;16(5):e0250779.
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34	Kulshreshtha A, Alonso A et al. Association of stress with cognitive function among older Black and White US adults. JAMA Network Open. 2023 Mar 1;6(3):e231860.
35	Moore JX, Andrzejak SE, Bevel MS, Jones SR, Tingen MS. Exploring racial disparities on the association between allostatic load and cancer mortality: a retrospective cohort analysis of NHANES, 1988 through 2019. SSM—Population Health. 2022 Jul 31;19:101185.
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38	Bahri N, Fathi Najafi T, Homaei Shandiz F, Tohidinik HR, Khajavi A. The relation between stressful life events and breast cancer: a systematic review and meta-analysis of cohort studies. Breast Cancer Research and Treatment. 2019 Jul;176(1):53-61.
39	Santos MC, Horta BL, Amaral JJ et al. Association between stress and breast cancer in women: a meta-analysis. Cadenos de Saude Publica. 2009;25 Suppl 3:S453-63.
40, 44, 46, 50, 54	Yang T, Qiao Y et al. Work stress and the risk of cancer: a meta-analysis of observational studies. International Journal of Cancer. 2019 May 15;144(10):2390-2400.
41	Butow P, Price M et al; kConFab investigators; kConFab Clinical Follow-Up investigators; kConFab psychosocial investigators. Does stress increase risk of breast cancer? A 15-year prospective study. Psycho-Oncology. 2018 Aug;27(8):1908-1914.
42	Yıldırım NK, Özkan M et al. Possible role of stress, coping strategies, and life style in the development of breast cancer. International Journal of Psychiatry Medicine. 2018 May;53(3):207-220.
48	Yang T, Qiao Y et al. Work stress and the risk of cancer: a meta-analysis of observational studies. International Journal of Cancer. 2019 May 15;144(10):2390-2400.
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