Expert Analyses How Stress Affects Outcomes in Ovarian Cancer

Stress and depression not only affect the quality of life of women with ovarian cancer, but it can also have a negative impact on their prognosis, according to Susan Lutgendorf, Ph.D., professor and Starch Faculty Fellow at the University of Iowa.

In an interview with CURE at the 2016 Society for Immunotherapy of Cancer (SITC) Annual Meeting, Lutgendorf discussed how stress affects the immune response in ovarian cancer cells, increasing inflammation and shortening survival outcomes.

“The bottom line is that we see that these behavior factors affect both the immune response as well as tumor progression,” Lutgendorf said.

When looking at patients who were matched for histology, age, cancer types and other clinical factors, Lutgendorf found that patients with high levels of distress, who may lack a strong social support system, have a poorer innate immune response and poorer T cell responses within their tumor-infiltrating lymphocytes. This has a negative impact on the effectiveness of immunotherapy. Patients with higher levels of depression also tended to have aggressive tumors that progressed more quickly because stress was increasing the ability of the tumor cells to travel through the lymph system, giving them another mode of transport that is not only blood-born.

“Those with high levels of depression have a gene signature that is related to greater levels of aggressiveness and tumor activation — the kinds of things that would underlie tumor progression,” Lutgendorf said. “To add to that, one of the things we've seen is that ovarian cancer patients with low levels of social support have about a year shorter survival than patients with high levels of social support in models that are controlling for a variety of clinical factors.”

Stress factors that were considered included: stress levels, depression status and support system.

“The bottom line here is that stress factors seems to promote tumor progression, deplete tumor-related immunity, and when you look at that packaged together, it's extremely nefarious in a way,” she said.

Lutgendorf said that she hopes more trials will be conducted to gain a firmer grasp on how stress affects outcomes in not only ovarian cancer, but in other tumor types as well. One interesting prospect she mentioned is the use of beta blockers, which are typically used in cardiovascular disease to treat hypertension, to block stress-related tumor progression.

“These trials are in the earlier stages,” Lutgendorf said. “But other promising trials are looking at mind-body interventions, like stress management interventions, mind-body interventions, mindfulness, yoga and tai chi.”

As these kinds of studies continue to publish results on the affects of stress in cancer tumors, Lutgendorf said that patients can employ strategies that may play a direct hand in the outcomes of their disease, such as diet and exercise, which play a key role in stress.

“I think many patients feel like they're in a situation where they don't have control over their life and it's in the hands of molecules and things with long names, and a medical system that is working with them,” she said. “Starting to understand what exercise, what diet and what stress or anti-stress factors, can help empower people and start to get control over their lives. That's an important direction that this kind of work can be used in.”