A new study recently published in Nature Medicine is quite personal, as I too had stage 3 melanoma over 5 years ago. In a groundbreaking study, researchers found a surprising connection between emotional distress and the effectiveness of the most promising melanoma treatment – immunotherapy. The study, part of the phase 2 PRADO trial, focused on neoadjuvant immunotherapy, a cutting-edge approach for advanced melanoma where immunotherapy is given before surgery, the approach that I received.
While getting immunotherapy before surgery for advanced melanoma has already shown superior results compared to immunotherapy after surgery, scientists were puzzled by the inconsistent responses among patients. To unravel this mystery, they explored potential biomarkers like interferon-gamma signature and tumor mutational burden but found them to be insufficient in explaining the variations.
Delving deeper, the researchers also examined the effects of emotional distress of the patients undergoing neoadjuvant immunotherapy. Preclinical studies and clinical studies show that high levels of stress hinder the body’s immune responses, and this the researchers hypothesized could potentially negatively affect treatment outcomes.
Using self-report measures of emotional functioning, the team identified two distinct groups: patients with pretreatment stress and those without stress. The results were eye-opening.
Patients with pretreatment stress showed a significant reduction in major pathologic responses at the time of surgery compared to their less stressed counterparts (46% versus 65%). The effects remained even after adjusting for other biological and clinical factors. The harms of stress extended beyond the immediate response, with stress leading to sooner recurrence of disease within the first 2 years (26% of those with stress versus only 9% with no stress) and having distant metastasis (22% versus 5%).
These results open the door to further investigation, emphasizing the need to understand the complex interplay between emotional well-being and the body’s ability to control melanoma or other cancers. As researchers delve deeper into this intriguing connection, we should focus on different ways to manage stress to optimize treatment outcomes.
Mind-body practices to help manage stress include meditation, various forms of yoga, and practices such as tai chi and qigong. These practices can help decrease stress by bringing balance to the body and, ultimately, to our lives. I, for one, try and engage in a stress management practice daily.
Image: Pedro Figueras
The thought that relentlessly haunts cancer survivors, even after successfully having their illness treated, is the fear of its return. This becomes especially salient around the time of getting regular post-treatment screenings. Unfortunately, even when we think the cancer is gone, it is common that some cancer cells remain and are dormant. Scientists have been studying how dormant cancer cells, which are inactive and hidden, can become active again and lead to cancer recurrence. A new study focused on the role of stress and a type of white blood cell called neutrophils and how stress can cause recurrence of disease.
The researchers discovered that stress hormones can make neutrophils release certain proteins called S100A8/A9, which cause inflammation in the body – one factor linked with increased risk of cancer. These proteins activate a substance called myeloperoxidase and lead to the buildup of harmful substances called oxidized lipids inside the neutrophils. When these lipids are released from the neutrophils, they stimulate the growth of cancer cells, causing them to wake up from dormancy and form new cancers.
In patients with lung cancer who had their tumors completely removed, higher levels of S100A8/A9 in their blood were linked to a shorter time until the cancer came back. However, the researchers found that by targeting either S100A8/A9 or certain receptors called β2-adrenergic receptors, which are involved in the stress response and cancer growth, they could prevent the reactivation of dormant cancer cells caused by stress.
These findings show that there is a connection between stress, the activity of specific neutrophils, and early recurrence of cancer. Managing stress is important for cancer patients, and here are three ways to do it:
Remember, managing stress is not only beneficial for your mental health but may also play a role in preventing cancer recurrence and improving your long-term outcomes.
Photo credit: Rhoda Baer