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Stress resilience in late adolescence and survival among cancer patients: a Swedish register-based cohort study
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)
Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0001-6328-5494
Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
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2019 (English)In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 28, no 2, p. 400-408Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Chronic stress has been suggested to play a role in cancer progression, but few studies have so far examined the potential influence of stress susceptibility. This national register-based cohort study utilizes a unique data source to investigate whether a stress resilience measure is associated with survival in cancer patients.

METHODS: The cohort includes 9,318 Swedish male cancer patients born during 1952-1956 who had their stress resilience evaluated at a semi-structured interview with a psychologist during mandatory conscription examination in late adolescence.

RESULTS: Over a median of 3 years of follow-up from cancer diagnosis, a total of 2,541 patients died (2,322 from cancer). Overall, low (23%) compared with high (25%) stress resilience was associated with increased mortality (adjusted hazard ratio estimated by Cox regression 1.45; 95% confidence interval 1.28-1.65), particularly among men with carcinomas of the oropharynx (2.62, 1.24-5.56), upper respiratory tract (4.64, 1.05-20.41), and prostate (2.20, 1.04-4.62), as well as with Hodgkin's lymphoma (3.52, 1.40-8.86). An association was evident both for cancer types associated with smoking (1.35, 1.10-1.66) and malignancies without an established smoking aetiology (1.32, 1.12-1.56). The association between low stress resilience and mortality could partly be explained by tumour stage, marital status, and psychiatric comorbidity at cancer diagnosis.

CONCLUSIONS: We observed an association between low stress resilience and mortality among men diagnosed with cancer, particularly, oropharyngeal cancer, upper respiratory tract cancers, prostate cancer and Hodgkin's lymphoma.

IMPACT: These results suggest that individual variation in stress resilience may influence survival among men with some cancer types.

Place, publisher, year, edition, pages
American Association for Cancer Research , 2019. Vol. 28, no 2, p. 400-408
National Category
Cancer and Oncology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-69907DOI: 10.1158/1055-9965.EPI-18-0451ISI: 000465321600019PubMedID: 30333220Scopus ID: 2-s2.0-85061062199OAI: oai:DiVA.org:oru-69907DiVA, id: diva2:1261136
Funder
Swedish Cancer Society, CAN 2013/650
Note

Funding Agency:

UK Economic and Social Research Council (ESRC)  RES-596-28-0001

Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2020-05-05Bibliographically approved
In thesis
1. Stress susceptibility, beta-blocker use and cancer survival
Open this publication in new window or tab >>Stress susceptibility, beta-blocker use and cancer survival
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Accumulating evidence suggests that chronic stress may influence tumour biology through activation of neuroendocrine pathways and thus impair survival. However, measuring stressful exposures and their influence on health is challenging, partly due to substantial inter-individual variation in stress susceptibility. The thesis aimed to explore whether stress resilience and use of β-adrenergic receptor blockers, which are implicated in regulation of neuroendocrine stress response pathways, are linked to survival after a primary cancer diagnosis using data from Swedish national registers. In a cohort of male cancer patients born during 1952-1956 who had their stress resilience assessed during a mandatory conscription examination in late adolescence, low compared with high stress resilience was associated with a higher overall mortality rate. Statistically significant reductions in survival were observed among men with carcinomas of the oropharynx, prostate, upper respiratory tract, and Hodgkin’s lymphoma. In a cohort of patients diagnosed with pancreatic adenocarcinoma during 2006-2009, β-blocker users had a lower pancreatic cancer mortality rate than non-users, particularly among patients without distant metastases at diagnosis. In a cohort of patients diagnosed with non-small cell lung cancer during 2006-2014, there was no clear association between β-blocker use and lung cancer survival, but we cannot exclude the possibility of associations in some sub-groups defined by histology, stage and β-blocker types. In a cohort of patients diagnosed with hepatocellular carcinoma during 2006-2014, β-blocker use was associated with lower liver cancer mortality, particularly among patients with localised disease. A higher-magnitude inverse association was observed for non-selective β-blocker use. In conclusion, greater stress resilience and β-blocker use are associated with improved survival among patients with some cancer types, and this may be explained by a variety of pathways.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2020. p. 101
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 212
Keywords
stress resilience, β-blockers, primary cancer, survival analysis, overall mortality, cancer-specific mortality, register-based cohort study
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-80720 (URN)978-91-7529-338-7 (ISBN)
Public defence
2020-05-28, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:15 (English)
Opponent
Supervisors
Available from: 2020-03-18 Created: 2020-03-18 Last updated: 2020-05-15Bibliographically approved

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Udumyan, RuzanMontgomery, ScottFall, Katja

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