Behavioral--physiological factors in the development and management of cancer

Recent clinical and animal model studies have demonstrated an effect of behavioral variables on the course of cancer. Unrelieved anxiety, helplessness, depression, and the inability to modulate the expression of anger have been implicated as specific predictors of poor prognosis. The endocrinological sequelae of these emotional states may affect certain parameters of cell-mediated immunity involved in host resistance to neoplasia. Both corticosteroids and catecholamines are likely mediators of behavioral effects on immunological function. Hormonal variations may also affect growth of tumors directly, or through nonimmunological tissue specific mechanisms. Behavioral interventions based on elicitation of the relaxation response provide a means of influencing affective and physiological states that may have particular relevance to cancer. Practice of such interventions reduces anxiety and provides a substrate for coping that enhances the patient's sense of control. Such "immunization" against helplessness can forestall depression. Physiological effects of such behavioral interventions occur both on a direct and an indirect level. Elicitation of the relaxation response per se produces physiological alterations consistent with decreased arousal of the sympathetic nervous system. Furthermore, by reducing fear and helplessness, physiological changes related to such dysphoric states may be minimized