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Psychological Stress and Cancer Risk and Outcome: An Umbrella Review With Quantitative Synthesis
Fausto Petrelli1, Chiara Abeni2, Emanuela Ceruti3
1Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy.
Asia-Pacific Journal of Clinical Oncology
|July 26, 2026
Summary
Psychological stress does not appear to increase cancer incidence. However, depression and anxiety are linked to higher cancer mortality, highlighting the importance of mental health in cancer prognosis.
Area of Science:
- Oncology
- Epidemiology
- Psychiatry
Background:
- Psychological stress is hypothesized to impact cancer development and outcomes.
- Existing epidemiologic evidence on stress and cancer is inconsistent.
- This study addresses the need for a comprehensive evaluation of stress-related exposures and cancer.
Purpose of the Study:
- To evaluate associations between psychological stress and cancer incidence and mortality.
- To synthesize existing systematic reviews and meta-analyses on the topic.
- To provide a quantitative synthesis of the evidence.
Main Methods:
- An umbrella review methodology was employed, searching multiple databases up to March 2026.
- Included systematic reviews, meta-analyses, and pooled individual participant data analyses.
- Random-effects models were used for quantitative synthesis, with credibility assessed using the Ioannidis framework.
Main Results:
- No significant association was found between psychological stress and overall cancer incidence (pooled RR/HR 1.06) or breast cancer incidence (RR/OR 1.13).
- Cancer mortality was consistently elevated across analyses (RR/HR 1.23), with specific risks for lung cancer (HR 1.15) and leukemia (HR 3.86).
- Associations between depression/anxiety and cancer mortality demonstrated Class I evidence.
Conclusions:
- Psychological stress exposures were not significantly linked to cancer incidence based on meta-analytic evidence.
- Depression, anxiety, and related distress were consistently associated with increased cancer mortality.
- Findings should be interpreted cautiously due to potential residual confounding and heterogeneity.
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