How can Managing Stress help me? 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 these pages:

How do integrative experts manage stress? ›

Managing your stress response ›

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).

Learn more about how we research and rate therapies and practices.

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

Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) of better survival among people with cancer as a whole with lower levels of stress

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

Kidney cancer

Preliminary evidence of moderately better survival among people with kidney cancer 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

Optimizing your body terrain

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

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

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

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

Inflammation

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 higher levels of markers of inflammation among people with post-traumatic stress disorder

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

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

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

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

Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of cancer 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

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

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

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

Kidney cancer

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

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

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

Prostate cancer

Strong 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

How Managing Stress relates to other practices and habits

Eating Well

Stress—and its related anxiety and depressive symptoms—and food choices are all related. Interventions to improve food choices may possibly reduce depressive symptoms and stress. The reverse—that reducing depressive symptoms and stress may improve food choices—might also be true.

Unhealthy food choices among a subgroup of people reporting stress (preliminary evidence)

Similar effects on physical markers of stress among women eating either healthy or unhealthy food choices in response to stress compared to no food (meaning there is no advantage from “comfort foods” on stress) (preliminary evidence)

Less stress among people eating a specific whole-grain food (preliminary evidence)

No evidence of an effect on stress among people following a vegan/vegetarian diet in a large combined analysis of studies

Higher stress responses among people consuming caffeine (preliminary evidence)

Some eating patterns and foods can promote stress. Integrative physicians Keith Block, MD, and Janet Spitzer, MD, inform us about foods, food components, and eating behaviors that promote a stress response:53Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Care. New York: Bantam Dell. 2009; Spitzer J. Personal communication with Laura Pole. April 16, 2018.

  • Low-carb, high-fat diet
  • Low-carb, high-protein diet
  • High ratio of omega-6 to omega-3 fatty acids ›
  • Foods containing caffeine
  • Overeating
  • Timing of snacks and drinks
    • Eating within one hour of bedtime
    • Eating a heavy evening meal or snack

Moving More

Lower physical markers of stress among people participating in exercise or movement, but not specific to people with cancer (modest evidence)

Sleeping Well

Stress—and its related anxiety and depressive symptoms—and sleep are all related. Interventions to improve sleep may possibly reduce depressive symptoms and stress. The reverse—that reducing depressive symptoms and stress may improve sleep—might also be true.

Poorer sleep quality among people with symptoms of stress (good evidence)

Higher levels of stress among people with lung cancer with poor sleep quality (preliminary evidence)

Creating a Healing Environment

Lower risk of stress-related disorders among people with more dense vegetation near their residences (modest evidence)

Lower blood pressure or heart rate among people with more exposure to nature (modest evidence)

Sharing Love and Support

Sharing Love and Support is connected to Managing Stress. Loneliness and isolation are stressors. Feeling supported and loved can help you manage these stressors.

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 among people with higher levels of social support (good evidence)

Fewer symptoms of posttraumatic stress and more posttraumatic growthpositive psychological change experienced as a result of adversity and other challenges among adults with cancer with higher levels of social support (modest evidence)

Resources

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Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Last update: October 15, 2022

Last full literature review: November 2021

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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