The British royal family has been shaken by multiple recent cancer diagnoses, with King Charles III, Kate Middleton (the Princess of Wales), and Sarah Ferguson (the Duchess of York) all receiving a diagnosis since the beginning of 2024.

 

Diagnosed royals

 

King Charles was told he had cancer shortly after he underwent treatment for an enlarged prostate, although the unspecified malignancy is not in the prostate, according to reports.

Similarly, the princess has not revealed what type of cancer she has, which was discovered after she underwent abdominal surgery. In a statement released last month, she said she is having “good days and bad days” as she undergoes chemotherapy. And Ferguson, who was diagnosed with skin cancer just 6 months after receiving treatment for breast cancer, is doing well, according to her daughter, Princess Beatrice, in an interview.

Ellis M. Kate Middleton shares update on her cancer and chemotherapy: ‘Not out of the woods’. TODAY. June 14, 2024.

Jacoby S, Vivinetto G. Everything we know about King Charles' cancer, from diagnosis to treatment. TODAY. March 25, 2024.

Sarah Ferguson: Duchess of York 'doing well' after double cancer scare, Princess Beatrice says. Sky News. May 6, 2024.

 

 

 

Indeed, chronic stress has been shown to play into the development or worsening of a number of health issues. Cancer is on that list, along with cardiovascular disease, diabetes, neurodegenerative disease, insomnia, and colds and infections.

 

A mixed bag of evidence

 

Although research has not provided a clear answer, there is some evidence to support a link between chronic stress—from caring for a sick family member or being out of work for a long period of time, for example—and poorer outcomes related to cancer, which itself sets people off on a stressful journey.

 

Another paper in BJPsych Advances focused on the impact of psychosocial stress among patients who already had cancer, reviewing 47 clinical studies published over a 14-year span.

Singh AK, Chatterjee U, MacDonald CR, et al. Psychosocial stress and immunosuppression in cancer: what can we learn from new research?. BJPsych Adv. 2021;27(3):187-197.

Of those, 44.6% demonstrated a harmful effect stress, while a larger proportion (48.9%) showed no association between stress and clinical outcomes and 6.4%, perhaps surprisingly, uncovered a protective effect of stress.

 

The National Cancer Institute (NCI) has highlighted the uncertainty of the association between chronic stress and cancer based on the varying results across studies, while noting that if there is a link, it may not be a direct one: “For example, people under chronic stress may develop certain unhealthy behaviors, such as smoking, overeating, becoming less active, or drinking alcohol, that are themselves associated with increased risks of some cancers.”

Stress and cancer. National Cancer Institute. October 21, 2022.

 

 

Stress may induce biological changes

 

Nevertheless, research has provided some hints about how chronic stress can induce physical changes within the body that increase susceptibility to cancer and its effects, according to the NCI.

Stress and cancer. National Cancer Institute. October 21, 2022.

 

Chronic stress also may lead to the release of glucocorticoids, which may inhibit tumor cell death, increase the likelihood of cancer spreading, and enhance resistance to chemotherapy.

Stress and cancer. National Cancer Institute. October 21, 2022.

 

A review in Frontiers in Physiology focuses on the contribution of inflammation in explaining a possible association between chronic stress and cancer, a relationship that works in both directions.

Vignjević Petrinović S, Milošević MS, Marković D, Momčilović S. Interplay between stress and cancer-A focus on inflammation. Front Physiol. 2023;14:1119095.

Psychological stressors kick off physiological responses that modify immune function and induce a pro-inflammatory state, which are involved in the development and progression of cancer, the authors explain, while tumor-induced inflammatory cytokines have a detrimental effect on the stress response.

 

If inflammation is a key player here, then anti-inflammatory therapies may have an important role to play, the review suggests.

Vignjević Petrinović S, Milošević MS, Marković D, Momčilović S. Interplay between stress and cancer-A focus on inflammation. Front Physiol. 2023;14:1119095.

 

 

How to mitigate stress-related risk

 

If the source of stress cannot be eliminated, there are steps that can be taken to dampen the effects.

There are a variety of vitamins, supplements, and foods that can help relieve stress, which will have downstream benefits in terms of preventing worsening health due to a number of medical conditions, including cancer.

The NCI proposes several ways people with cancer in particular can bring down their stress levels, pointing to emotional and social support, which have shown benefits in some studies, and physical activity, which can alleviate anxiety and depression.

Stress and cancer. National Cancer Institute. October 21, 2022.

If the stress is severe enough, you can refer patients to a mental health professional for further assistance in the form of psychotherapy, treatment with antidepressants or other medications, or both.

 

The University of Texas MD Anderson Cancer Center suggests additional possibilities, including practicing meditation or yoga and obtaining an adequate amount of sleep.

How stress affects cancer risk. The University of Texas MD Anderson Cancer Center. December 2014.