Cancer, stress and the workplace: the growing imperative

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With evidence growing that stress can prompt the re-emergence of cancer, it is increasingly important that employers look closely at their workplace approach to stress management.

Science constantly tests our assumptions about what is ‘real'. More and more research is questioning any easy division between our mind and our bodies (or matter in general) across many intellectual fields, from artificial intelligence, to architecture, to the medical sciences. Psychosomatic medicine is one exciting area that is investigating these relations between mental and physical states, for example how one can affect the other and whether we can establish causal relationhips between these states to explain observable phenomena in either state.

Fascinating epidemiological research by Susan K Lutgendorf PhD and Anil K Sood MD (Biobehavioral Factors and Cancer Progression: Physiological Pathways and Mechanisms) looks at the connection between stress and cancer, in particular its progression through the body. It examines what kind of behaviours can influence how cancer spreads and/or whether cancer returns, rather than whether stress (or to use the more accurate and general term ‘biobehaviour’, which takes in depression, isolation, trauma etc) causes cancer in the first place.   

Cancer-related mortality largely results from the spread of cancer cells from the primary tumour to other sites of the body, a process called metastasis. It is the mechanisms and environments that lie behind metastasis that can be affected by complex interactions at the biochemical and biobehavoural levels.

The research examines the effects on the nervous systems of the body (central or sympathetic/autonomic), when certain neurohormones associated with biobehavoural factors like stress are released. The paper looks at how the immune response can be affected by changes to these nervous systems, and whether decrease in the immune system are associated with the spread of tumours.

Some of the examples in the research this paper calls upon to demonstrate such links include "breast cancer patients following surgery, where low social support and distress have been linked with decrements in indicators of cellular immunity," or a study that "reported that depressed patients with hepatobiliary carcinoma (liver cancer) had shorter survival compared to their non-depressed counterparts". And among "colon cancer patients loneliness relates to higher levels of tumour VEGF at the time of surgery".

Research like this will certainly open up new areas of study when it comes occupational health, particularly given the prevalence work-related stress (recognised by EU-OSHA in its campaign, Healthy Workplaces Manage Stress). As the paper says, "the emerging body of literature provides compelling evidence that stress-related behavioural factors can modulate physiological pathways relevant to cancer control". The paper makes clear that psycho-social activities like support, care and stress management will be an important response to reduce the risk of cancer spreading or returning.

As the evidence strengthens, it is increasingly imperative that anyone involved in the support of individuals at work who are living with cancer must look closely at their workplace approach to stress management. 

The British Safety Council's guide to managing stress at work: https://www.britsafe.org/system/files/A5_guide_Managing_stress_at_work.pdf



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