Stress, depression may fuel head/neck tumor growth

Stress and depression are associated with tumor growth in head and neck cancer patients, and they can shorten the time that such patients are able to survive disease-free, according to a study presented April 28 at the Society of Behavioral Medicine annual meeting in Washington, DC.

Previous research has shown that stress can affect the immune system and weaken the body's defense against infection and disease. In cancer patients, this stress can also affect a tumor's ability to grow and spread.

Now, researchers at the Fox Chase Cancer Center in Philadelphia have found that poor psychosocial functioning is associated with greater vascular endothelial growth factor (VEGF) expression -- a signaling protein that stimulates tumor growth and is also associated with shorter disease-free survival in head and neck cancer (HNC) patients.

"We found that the biomarker had prognostic value," said lead study author Carolyn Fang, PhD, co-leader of the Cancer Prevention and Control Program at the Fox Chase Center.

VEGF not only plays a pivotal role in angiogenesis, but it is also regulated by stress hormones and key cytokines -- a category of signaling molecules used extensively in intercellular communication, the researchers noted.

Fang and colleagues looked at 37 newly diagnosed, presurgical HNC patients to see if psychosocial functioning, such as perceived stress and depressive factors, was associated with VEGF, a biological pathway relating to patient outcomes. The patients were predominantly male (70.3%) and approximately 57 years old, with primary tumor sites of the oral cavity (65.9%), larynx (18.9%), and oropharynx (13.5%). More than 40% of them were classified as having early-stage disease.

Patients completed psychosocial questionnaires prior to treatment concerning their social support, depression, and perceived stress. In addition, VEGF expression in tumor tissue obtained during surgery was evaluated using immunohistochemistry -- a process that helps detect the presence of specific proteins in cells or tissues.

The associations between psychosocial functioning and VEGF were strong among early-stage patients, but less apparent among late-stage patients, the researchers found.

"Preliminary analyses suggest that the association between depression and VEGF was a little bit more robust among patients who have early-stage disease, while the relationship was more modest among patients with more advanced disease," Fang explained. "When you have advanced disease, there are a whole host of biological factors that are going on, and that probably overwhelms any more modest association we might be observing."

Fang and her colleagues hope to expand the study to look at a larger sample of patients and incorporate other signaling pathways that are relevant to cancer, such as epidermal growth factor receptor.

"We want to expand this, maybe to a longitudinal study, so we can follow these patients over time and obtain multiple assessments, and examine whether or not changes in psychosocial functioning are associated with corresponding changes of some of these markers," she told DrBicuspid.com. "That would give us a little more confidence to move forward and see if there's an intervention here that would be relevant to early-stage patients that may have a beneficial impact, not only in psychosocial well-being but physical well-being as well."

The study is preliminary and cross-sectional, Fang noted, and cannot be used to determine any cause or effect between psychosocial issues and disease progression.