Stress, cancer and immunity. New developments in biopsychosocial and psychoneuroimmunologic research

Research in biobehavioral oncology has been focused on stress as one dispositional factor in the multifactorial origin and in the clinical progression of malignant disease. New insights into the transduction of environmental influences to the immune system and to other body systems by the brain and neurotransmitters have increased the salience of this approach. Behavioral medicine in the area of cardiovascular disease has been successful due to the introduction of a "Type A" or coronary prone behavior pattern in large epidemiologic studies. This pattern is marked by both psychologic and physiologic hyperresponsiveness. Type A persons appear to be hostile, easily angered, competitive and hard-driving. More recently, behavioral oncologists have similarly attempted at conceptualizing a "Type C" or biopsychosocial cancer risk pattern, as they have noted the denial and suppression of emotions, in particular anger. Other features of this pattern are "pathological niceness", avoidance of conflicts, exaggerated social desirability, harmonizing behavior, over-compliance, over-patience, as well as high rationality and a rigid control of emotional expression ("anti-emotionality"). This pattern, usually concealed behind a facade of pleasantness, appears to be effective as long as environmental and psychological homeostasis is maintained, but collapses in the course of time under the impact of accumulated strains and stressors, especially those evoking feelings of depression and reactions of helplessness and hopelessness. As a prominent feature of this particular coping style, excessive denial, avoidance, suppression and repression of emotions and own basic needs appears to weaken the organism's natural resistance to carcinogenic influences. This may mean that the excessive use of denial and suppression/repression has important psychophysiologic effects linked to tumor biology and host-defense. Recent studies reveal that psychosocial stressors which are met by inadequate and repressive coping styles are associated with changes in immunocompetence, including both humoral and cell-mediated immunity. Relationships between different immune parameters (natural killer cell activity, lymphocytes, serotonin uptake, mean platelet volume) and mood states, psychological coping styles and personality variables are outlined. Recent findings indicate also that in certain malignancies (eg. breast cancer) the clinical course of the disease is influenced by psychosocial factors and coping style, as well as that the risk of cancer recurrence and metastasis is influenced by the type and duration of a given stressor. Individuals with a more favorable outcome have higher fighting spirit, a greater potential for aggression and lesser suppressive tendencies. Psychological intervention in cancer patients in its different forms and within the frame of the over-all treatment has now become a matter of scientific discussion and research.(ABSTRACT TRUNCATED AT 400 WORDS)