Allostatic load in female cancer patients: a systematic review

The physiological burden of chronic stress, quantified as allostatic load (AL), is implicated in cancer development and outcomes. However, a synthesis of evidence regarding its role in female-specific cancers is lacking.

This systematic review aimed to synthesize existing evidence on the application of AL in female cancer patients, covering both its predictive value for cancer risk in healthy populations and its prognostic significance for outcomes and quality of life in cancer patients.

Following PRISMA guidelines, we systematically searched PubMed, Web of Science, Springer Link, and Wiley Online Library from inception to June 2025. Studies investigating AL in patients with common female cancers (e.g., breast, endometrial, ovarian) were included. Study quality was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data on study characteristics, AL assessment methods, associated factors, and key findings were extracted.

17 studies (14 on breast cancer, 2 on endometrial cancer, and 1 on ovarian cancer) were included. AL levels were influenced by sociodemographic, lifestyle, and structural factors. Higher AL was associated with an increased risk of female cancers (particularly breast cancer) incidence, poorer health-related quality of life, a higher incidence of postoperative complications (e.g., lymphedema), and increased all-cause mortality. And existing studies exhibit heterogeneity in biomarker selection and scoring thresholds.

AL is a promising composite marker associated with the risk, prognosis, and quality of life in female cancer patients, primarily breast cancer. Current evidence is concentrated on breast cancer with limited evidence available for other types of female cancers. Future research requires standardized AL assessment and investigations across diverse female cancer populations.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251080672.