Tuesday , March 21 2023

Stress in patients with cervical cancer associated with a higher risk of cancer-specific mortality


Bottom line: Psychological stress is associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Journal in which the study was published: Cancer research, a journal of the American Association for Cancer Research

Author: Donhao Lu, MD, PhD, MD, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.

Background: "Patients diagnosed with cancer are at increased risk of several stress-related psychiatric disorders, such as depression, anxiety and stress and adjustment disorders," Lou said. "Evidence from both experimental and epidemiological studies suggests that psychological distress can influence the progression of many cancers."

How the study and results are conducted: In this study, researchers investigated the potential impact of stress on cancer-specific mortality in patients with cervical cancer. They checked the records of 4245 patients diagnosed with cervical cancer in Sweden between January 1, 2002 and December 31, 2011. Using Swedish personal identification numbers, they linked patients to the Swedish Patient Registry, which collects nationwide information on hospital hospital records and specialist visits. Data from this registry was used to identify patients who were clinically diagnosed with any of three psychiatric disorders: stress and adaptive disorders, depression and anxiety.

Researchers also identify patients who have experienced a stressful life event, such as the death or serious illness of a family member, divorce or residence between jobs, as these events will further reflect the emotional burden for patients, explained Lou.

Researchers used the cause of death register in Sweden to identify women who had cervical cancer or unspecified cancer of the uterus as the main cause of death. During the follow-up period, 1,392 patients died and cervical cancer was reported to cause 1,005 of them.

Overall, the researchers found that 1,797 patients either had a stress disorder or had a stressful life event. Patients with either a stress disorder or a stressful life event are 33 percent more likely to die from the disease than those who did not report stress. Those who have had a stress disorder are 55 percent more likely to die from cervical cancer, and those who have experienced a stressful life event are 20 percent more likely to die from their disease .

Lou pointed out that the relationship of stress with a higher risk of dying from cervical cancer remains independent of the tumor's characteristics, its diagnosis and the type of treatment. Associations were also consistent with demographic groups and clinical characteristics.

Author Comments: Lou said there were several possible explanations for the link between psychological distress and mortality specific to cervical cancer. For one, a woman suffering from a psychological disorder may be less likely to seek treatment and may be diagnosed at a later stage. Biologically, he noted, previous research has shown that chronic stress can reduce the cellular immune response, which can affect the progression of infection-related infections, such as cervical cancer. In addition, a previous study by Lou and colleagues further supports the role of psychological distress in the development of cervical cancer, potentially through oncogenic infection of the human papillomavirus.

Partner Karin Sundstrom, MD, project coordinator at the Department of Laboratory Medicine, Karolinska Institutet, said that in Sweden, psychological support is offered to patients in large university clinics, but not in smaller regional institutions. She said many patients do not receive emotional support, in part because of lack of awareness that emotional distress can absorb.

"Our findings support that oncologists or gynecologists actively evaluate psychiatric status on return visits to see how patients with cervical cancer cope, not only somatically but also mentally," Sundström said. "If confirmed in other populations and countries, psychological screening and intervention can be considered an integral part of cervical cancer care."

Limitations of the study: Lou indicated that this study suggests a relationship between stress and prognosis for cervical cancer and should not be interpreted as a cause-and-effect relationship.

Funding and Disclosures: This study was supported by the Swedish Cancer Society, the Swedish Research Council on Health, Work Life and Wellbeing and the Karolinska Institutet. The authors declare that there is no conflict of interest.


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