Cancer and Stress: A Deadly Duo That Doctors and Patients Must Manage Together

Research warns of a vicious cycle between stress, cancer, and microbes that starts at the moment of diagnosis.

Illustration by The Epoch Times, Shutterstock

Dana Voigt had just traveled to Italy and hiked up thousands of stairs. She had felt amazing and had no symptoms of illness.

But after returning home, a routine mammogram revealed she had invasive lobular carcinoma—a hard-to-detect cancer that starts in milk-producing glands that turned her life into a whirlwind of information, appointments, and decisions.

Dana Voigt in Italy. Dana Voigt

Worst of all, while she wanted time to understand and absorb each bit of news, Ms. Voigt felt like her cancer team put her in a game of “beat the clock” that left no time to get a second opinion.

“I can’t think of anyone I’ve met who wasn’t overwhelmed and thrown into a tizzy on how to make a decision on something you have little to no experience with and you don’t even know what to ask or who to believe. You pretty much base everything on what the doctor and cancer team is telling you,” she said. “I was lost. I didn’t know which way to go, or how to think. I was in panic mode.”

There was something different about her breast cancer anxiety; Ms. Voigt described it as something she just couldn’t contain despite how hard she tried. Runaway emotions are common with a cancer diagnosis and treatment decisions—a major factor that undermines patient outcomes.

Research indicates that this is a tragic result of doctors, cancer clinics, and other health care workers neglecting to help patients reduce stress.

The Microbe Dimension

Anxiety is particularly troublesome for newly diagnosed cancer patients because stress has been shown to damage the gut microbiome, which is intimately connected to the immune system and predicts the success of some cancer therapies—both tied to prognosis.

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The gut and brain are in constant communication, with countless compounds and microbes influencing this intricate interdependency. Illustration by The Epoch Times, Shutterstock

New research has recognized this dilemma in a study that examined the intersection of the gut microbiome—the community of trillions of mostly bacteria, viruses, and fungi living in the gastrointestinal tract—and stress in the newly diagnosed breast cancer patient. The verdict: Patients who reported feeling distressed had marked differences in their microbial community that have been linked with various cancers, inflammatory bowel disease, poor treatment responses, and other negative traits that can affect quality of life even beyond treatment.

Published on Oct. 20, 2023, in Scientific Reports, the study pinpointed treatment decisions as the most frequently cited source of stress. Decisional distress can involve uncertainty, anxiety, and regret.

In other words, stress arising from a cancer diagnosis can also directly contribute to cancer itself. This raises the question of what doctors and cancer clinics can do to reduce stress and thereby improve cancer outcomes.

An article written for clinicians in Patient Education and Counseling in 2021 emphasized that breast cancer is accompanied by a special kind of stress that physicians need to be aware of when evaluating treatment decisions and eliminating confusion. The authors of the new study argue that because female breast cancer has surpassed lung cancer as the most diagnosed cancer—and because survival rates have gone up—improving quality of life is a worthwhile focus in research.

Patients, then, can also use new understandings of stress and its connection to the microbiome to enhance their microbial community—and prognosis—through lifestyle changes.

Microbiome’s Role in Breast Cancer

The new study builds on breast cancer research linked to the gut microbiome. The microbial community drives many metabolic, neural, and endocrine processes. It also acts as a gatekeeper of sorts for the human immune system, mostly by keeping pathogenic bacterial populations in check.

The microbiome is of keen interest to cancer researchers who are looking for ways to rev up the immune system through bacterial composition and interplay. Improvements in the immune system could allow the body to deal directly with cancerous cells.

Some previous findings related to the microbiome and breast cancer include the following:

• Specific microbes and the diversity of the microbial community have been linked to chemotherapy response and prognosis in patients. For instance, some bugs indicate a poor response to chemotherapy, whereas others show a beneficial response. Microbiota can predict chemotherapy-associated toxicity.
• An imbalance of microbiota, called dysbiosis, may lead to the development of breast cancer.
• Manipulating commensal bacteria—including using prebiotics and probiotics—has proven cancer-fighting potential in some patients.

Christine Holcomb encouraged the growth of disease-fighting microbes when she opted to forego chemotherapy and instead boost

Christine Holcomb Christine Holcomb

her immune system with raw foods, supplementation, and detoxification. Though she didn’t realize she was nurturing her microbiome at the time of her 2011 breast cancer diagnosis, it’s a concept she’s now become more familiar with.

“Your microbiome changes and that might have allowed breast cancer to develop,” she told The Epoch Times. “But if you get out of your chronic stress, your microbiome may change back, and it helps your immune system fight everything.”

Ms. Holcombe had a double mastectomy, healed from her breast cancer, and went on to become a public speaker on how to survive cancer and prevent it from coming back.

A Tale of 2 Microbiomes

The new study took a detailed look at the microbiomes of 82 breast cancer patients and noted significant differences in bacterial families and genera that coincided with distress and quality of life.

Specifically, those with high levels of distress had more abundant Alcaligenaceae and Sutterella bacteria. Alcaligenaceae is a bacterial family that is associated with irritable bowel disease (IBD), chronic kidney disease, and several types of cancers. These bacteria—which are pro-inflammatory and typically higher in patients with depression without anxiety—are believed to play a role in the development or progression of disease, according to the study.

Sutterella has been linked to a variety of diseases including IBD, Crohn’s disease, and multiple sclerosis, among others, the research said. An abundance of sutterella seems to be associated with better cancer therapy outcomes, and a lower abundance has been linked to people with depression, as well as people who sleep less.

The family of Streptococcaceae was also more significantly abundant in those with lower distress scores in the study. Many of the bacteria in this family are health protective, help balance neurotransmitters, and have the ability to produce serotonin.

Computer illustration of bacteria of different shapes, including cocci and rod-shaped bacteria. Kateryna Kon/Shutterstock

However, Streptococcaceae research is a bit contradictory when it comes to mental health. For instance, research has noted that children who are diagnosed with neuropsychiatric disorders have suffered a streptococcal infection in the year prior.

Microbiome research is still in its infancy, and much about this complex ecosystem remains unknown. Still, Ms. Holcomb—who’s a board member of the holistic cancer support group Healing Strong—said new insights about stress can shape how cancer patients are supported in their healing.

Could Urgency Be Problematic?

The urgency of treatment is something that may be contributing to stress, she said, though newer “watchful waiting”—or active surveillance—approaches are becoming more acceptable in certain scenarios.

“All these bad things come in your head when you first get the diagnosis. They rush you, want you to hurry up. Even though that cancer’s probably been growing for 10 years, they want you in that surgery in a month. Not all doctors are like that though, but that adds to the stress,” Ms. Holcomb said.

That urgency is partly because research findings link treatment delays with poorer outcomes for certain cancers. But the causes of those delays are also an important factor. In some cases, delays arise from overload in the medical system, in which case patients are likely worried about their well-being. Delays also arise as a result of patients grappling with highly stressful treatment decisions—another scenario that can worsen outcomes.

It’s not uncommon for breast cancer patients to report “clinically significant levels of distress,” including angst over treatment decisions that can even continue for years, according to the 2021 article in Patient Education and Counseling.

Research even indicates that the severity and longevity of suffering among some breast cancer patients can mimic responses to trauma. Breast Cancer Now, a research and support group, said that while a diagnosis of post-traumatic stress disorder is rare among breast cancer patients, they may experience some of the symptoms such as flashbacks, feeling detached, or feeling emotionally numb.

Confusion Leads to Anxiety

The Patient Education and Counseling article said those who described their relationship with practitioners as trusting and supportive had reduced psychological distress—and they were more satisfied with the decisions made. On the other hand, some patients felt communication was confusing, and they left appointments with unanswered questions.

“Decisional distress is important because it is expected to play a role in quality of life and decision satisfaction for breast cancer patients. Negative affectivity surrounding decision-making may contribute to overall distress, and general distress may contribute to negative emotions about treatment decisions,” the article stated.

Ann Fonfa, who was diagnosed with breast cancer in 1993, told The Epoch Times that the health care system is missing an opportunity to offer meaningful help to patients. She’s the founder of the Annie Appleseed Project, a nonprofit organization that helps patients interested in learning about alternative cancer treatments.

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“When you’re at the cusp of making a decision that is complicated, that’s the worst time of your life because you’re not sure what direction to go in,” Ms. Fonta said. “It’s stress-producing, and it’s clear that it can be measured. Once people can determine what their next step is, they are a lot better off than while they’re thinking about it. It’s a real problem figuring out what to do.”

The Burden of Weighing Infinite Options

Most oncologists will discuss only medical treatments such as surgery, radiation, chemotherapy, hormonal therapy, immunotherapy, and targeted therapy. Within each of these exists a range of additional choices to be made depending on the type of breast cancer, as well as the stage, size, location, and growth rate of the cancer. Approaches may also take into account the health status, age, menopausal status, and preferences of the patient.

A dizzying amount of decisions can be compounded by balancing life decisions since many breast cancer patients are women who work outside the home, as well as being caregivers to other family members, Ms. Holcomb pointed out.

Also weighing on many patients’ minds is whether they may need a mastectomy—surgical removal of one or both breasts.

“They don’t really tell you about what it’s going to be like, and I consider it an amputation,” Ms. Voigt said. “Even though it’s a body part I don’t need and can function without it, it’s still a missing piece. Some of that is stuff I dwelt on a lot in the beginning.”

Patients who receive chemotherapy or take Tamoxifen have an elevated risk of stroke as a side effect. Even though she didn’t have those risk factors, Ms. Voigt had high blood pressure and anxiety and had a stroke a month after her mastectomy.

As such, she was nervous about the risk of another stroke and objected to Tamoxifen, which her oncologist continued to recommend to her repeatedly. Her anxiety persisted since her September 2019 diagnosis, though she is finally beginning to feel more like her normal self.

Metastasis and Stress

Ongoing stress is especially problematic for cancer patients, because metastasis—cancer spreading to additional sites—is a concern during treatment. 

Cancer can metastasize or spread through the blood circulatory system when cancer cells from the original tumor break off and get carried to other places in the body. This process can also occur in the lymphatic system, which has a network of vessels similar to the circulatory system. Shutterstock

A 2016 study in Molecular and Cellular Oncology demonstrated how cancer may metastasize when the nervous system is stuck in “fight or flight,” or chronically turned on. Neural-inflammatory signals change lymphatic tissues and vasculature, which increases lymph flow. Patient prognosis becomes more dismal once tumor cells invade the lymphatic system.  

It’s not uncommon for doctors to recommend manual lymphatic drainage after surgery for breast cancer patients. Gentle pumping massage by a trained specialist can help the lymph flow properly in situations in which lymphedema—swelling that can occur after surgery—is a risk. 

Deep breathing can help, too, for both stress reduction and improved lymph flow, Kelly Kennedy, a certified massage therapist, told The Epoch Times. 

“As you exhale out, release the tension in the body and create more space in the body. What we all need to create in our life is space, and that space starts within. Most people I know are hoarders of their emotions and their toxicants,” she said. 

Taking Simple Steps

Even well-meaning information can become burdensome, as patients often take on the responsibility of researching diet, stress-reduction tools, new studies, and more.

“We tell them so much that we can overwhelm them ... and the last thing you want is stress,” Ms. Holcomb said. “I always tell people when they can’t figure it out, pray for discernment. We tell them to go at their own pace, and if it feels right, they will know. Hope is important. It takes the stress away.”

Incidentally, many treatment options available outside conventional models are behavioral changes that influence both stress and the microbiome.

“The focus of what I do is showing people they don’t have to just do the conventional treatment with all the harms everyone knows are involved. They can also do complementary therapies and potentially reduce the treatment toxicities,” Ms. Fonfa said. “I feel like our system betrays people by not offering those options immediately. And this study proves it in my mind.”

Help Beyond the Hospital

The American Society of Clinical Oncology (ASCO) said complementary options are helpful to manage the side effects (stress, nausea, and vomiting) of treatment, such as music therapy, mindfulness meditation, stress management, yoga, acupressure, and acupuncture.

Acupuncture is a low-risk treatment that can be surprisingly effective. Bjoern Wylezich/Shutterstock

However, the organization warns that “most natural products are unregulated, so the risk of them interacting with your treatment and causing harm is uncertain.”

ASCO and Breast Cancer Now offer these additional tips:

• Get distracted—Learn a new hobby or take up an interest.
• Meditate/visualize/relax—These practices can relax the mind and body.
• Be organized—Break down tasks, seek help, and use tools to keep track of treatment and everyday life.
• Get counseling—Either with a professional or a confidant, talk to someone you can trust about your feelings.
• Be physically active—Regular exercise can be good for the body and the mind.
• Take up yoga/tai chi/qigong—Ancient practices can reduce stress.
• Get outside—Sunlight, fresh air, and the sounds of nature are all soothing.
• Eat well—Choose real food for nourishment.
• Get adequate sleep—Sleep is vital for immunity. Shoot for seven hours per day.
• Join a support group—Talking to others who understand is helpful, and groups can offer information and education beyond what you find in a doctor’s office.
• Do something relaxing—If you enjoy gardening, listening to music, reading, or sitting with your pet, make the time to do these things you enjoy.
• Laugh—Consider reading a funny book or watching a comedy.
• Write in a journal—The act of writing out feelings is therapeutic.

Consider Detoxing

Another important consideration that can affect the microbiome, Ms. Holcomb said, is to cut back on exposure to toxins such as pesticides and flame retardants, antibacterial products, artificial sweeteners, and sources of chronic stress. A cancer diagnosis can be a good opportunity to address emotional well-being.

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“I know people will do everything to heal. They will do surgeries. They will do diets, clean up everything, and detox, and they’re still not getting better and the cancer is not moving. But then as soon as they forgive or deal with something chronic from their past, they begin to heal,” she said.

Two popular methods for this kind of emotional work are cognitive behavioral therapy and journaling.

A 2021 review article in BioPsychoSocial Medicine found that cognitive behavioral therapy—talking to a trained therapist—is effective for mental problems, physical conditions, and behavioral problems. It also concluded that self-help and online therapy might also be able to help someone manage mental and physical issues.

People who journal about their most traumatic experiences have been found to experience significant physical and mental health improvements. A 1997 study published in Psychological Science about writing about emotional experiences as a therapeutic process has been referenced frequently by the Huberman Lab podcast. The study was based on a specific model of writing for 15 to 30 minutes without ceasing during several sessions.

“You can remove stressors. There are so many ways. It depends on you,” Ms. Holcomb said.