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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: 2019-05-03Bibliographically approved

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Udumyan, RuzanMontgomery, ScottFall, Katja

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