Emotional experiences and psychological stress associated with a cancer diagnosis and the subsequent therapies can influence the activity of the immune system. This, in turn, has an effect on the state of health and potentially even on the course of the disease.
How often do you meet patients with good coping strategies in your medical practice? More and more studies suggest that it is not only the diagnosis that determines the course of the disease, but also how the person being treated thinks about it.
Tumor cells and the immune cells in the tumor micro-environment can release cytokines that activate the immune system. These are called paraneoplastic symptoms. Unfortunately, the process of diagnosis itself generates a storm of pro-inflammatory messengers as a result of the strong and negative emotions triggered.1,2 Radiation or chemotherapy can also stimulate the formation of inflammatory mediators.3,4
The increased inflammatory activity can in turn cause symptoms of illness, such as fatigue, pain, physical illness, nausea or cachexia. This constellation, also known as "sickness behavior", is understood as an adaptive acute phase condition in which the body initiates an organized biological defense reaction. However, this sickness behavior itself can also increase the inflammatory responses in the body5 - thus creating a vicious circle of inflammation and disease behavior.
Although sickness behavior may be useful in responding to infection, it can be detrimental to cancer patients if peripheral immune system activation or emotional distress persists and exacerbates the vicious circle, ultimately exhausting the person's resources.4
A landmark study looked at successful disease management or emotional acceptance as a way to break this vicious circle.4 Emotional acceptance is a willingness to feel both positive and negative feelings or to allow them to arise and dissolve without trying to fight them off, change or control them.
In breast cancer patients, this attitude is associated with less stress, fewer depressive symptoms and increased positive benefits (e.g. perception of positive changes, such as closer relationships or a stronger perception of the importance of life).6-8 More importantly, emotional acceptance is associated with better survival.9
For the study, 136 women with a recent breast cancer diagnosis were followed up for 2 years. Plasma levels of various cytokines were measured every 3 months and disease processing was assessed using several validated psychological tests (FACT: Physical Well-Being Scale, Acceptance of Emotion Scale).
It was important that each woman was compared with herself, not with other patients. Each patient was therefore given her own average score for emotional acceptance, in order to take into account different levels of optimism. Someone who is naturally pessimistic would therefore have a lower starting point.
Higher plasma concentrations of TNF-α, interleukin-6 and interleukin-8 were overall predictive of more disease symptoms. Women with low scores (by their standards) for emotional acceptance had more disease symptoms and inflammatory cytokines, especially IL-8 and TNF-α. With improved emotional acceptance, plasma levels decreased.
IL-8 is a very important cytokine in the context of breast cancer. Firstly, because breast cancer cells produce it themselves, and secondly because it triggers further cascades of inflammation that can misregulate the immune system and thus promote metastasis.1, 10
But the most amazing issue is yet to come: strong emotional acceptance was accompanied by less "sickness behaviour" even when IL-8 and TNF-α were high. The researchers interpreted this to mean that effective emotional coping can break the link between inflammatory mediators and disease symptoms or break the vicious circle.
Unfortunately, the reverse is also true: women with poor emotional acceptance already suffered more symptoms at low IL-8 levels than women with higher acceptance.
The symptoms associated with "sickness behavior" can significantly affect the quality of life of patients, breaking the vicious circle described above could therefore improve the quality of life and survival of breast cancer patients.4, 9 The results of the study suggest that emotional acceptance may influence the association of cytokines with disease symptoms in breast cancer patients and that disease management as a therapeutic target may help to break the vicious circle of inflammation and disease symptoms.
For a more in-depth study of the topic, we recommend the 2006 award-winning book The Biology of Belief by the renowned cellular biologist Bruce H. Lipton, Ph.D. Even back then, he described in an exciting and accessible way for laymen, the molecular and epigenetic mechanisms by which emotions affect all our cells and how, for example, constant stress and negative thoughts can strongly influence our genes to express what ultimately leads to health or illness.
References:
1. Want to ‘Beat’ Cancer? End the Fight. Kelly Brogan MD https://kellybroganmd.com/want-to-beat-cancer-end-the-fight/ (2018).
2. Janelsins, M. C. et al. Differential Expression of Cytokines in Breast Cancer Patients Receiving Different Chemotherapies: Implications for Cognitive Impairment Research. Support Care Cancer 20, 831–839 (2012).
3. Grivennikov, S. I., Greten, F. R. & Karin, M. Immunity, inflammation, and cancer. Cell 140, 883–899 (2010).
4. Reed, R. G. et al. Emotional Acceptance, Inflammation, and Sickness Symptoms Across the First Two Years Following Breast Cancer Diagnosis. Brain Behav Immun 56, 165–174 (2016).
5. Segerstrom, S. C. & Miller, G. E. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychological Bulletin 130, 601–630 (2004).
6. Jensen, C. G. et al. What to listen for in the consultation. Breast cancer patients’ own focus on talking about acceptance-based psychological coping predicts decreased psychological distress and depression. Patient Education and Counseling 97, 165–172 (2014).
7. Wang, Y. et al. Cognitive emotion regulation strategies as predictors of depressive symptoms in women newly diagnosed with breast cancer. Psycho-Oncology 23, 93–99 (2014).
8. Wang, Y. et al. What factors are predictive of benefit finding in women treated for non-metastatic breast cancer? A prospective study. Psycho-Oncology 24, 533–539 (2015).
9. Weihs, K. L., Enright, T. M. & Simmens, S. J. Close relationships and emotional processing predict decreased mortality in women with breast cancer: preliminary evidence. Psychosomatic Medicine 70, 117–124 (2008).
10. Lippitz, B. E. Cytokine patterns in patients with cancer: a systematic review. The Lancet. Oncology 14, e218-228 (2013).