Psychological Stress and Cancer-Specific Mortality in Patients With Cervical Cancer


Key Points

  • Psychological distress is associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer, independent of tumor characteristics, mode of diagnosis, and type of treatment.
  • Patients with either a stress-related disorder or a stressful life event were 33% more likely to die of their cervical cancer than those who had not reported stress. Those patients with stress-related disorders were 55% more likely to die from their cervical cancer, and those who had experienced a stressful life event were 20% more likely to die of their disease.
  • The integration of psychological screening and intervention in the clinical management of patients with cervical cancer, especially at the time of a cancer diagnosis, may be considered an integral component in cervical cancer care.

Results from a large cohort study showed that psychological stress is associated with increased cancer-specific mortality among women with cervical cancer, independent of tumor characteristics and treatment modality. The findings support the integration of psychological screening and intervention in the clinical management of patients with cervical cancer, especially at the time of diagnosis. The study by Lu et al was published in Cancer Research.

Cervical cancer is the fourth most common cancer and cause of cancer-related death in women worldwide, according to the World Health Organization, with an estimated 570,000 new cases in 2018. This year in the United States, approximately 13,170 new cases of invasive cervical cancer will be diagnosed, and about 4,250 women will die from the disease, according to data from the American Cancer Society. Although emerging evidence suggests psychological factors—including depression, anxiety, or stress reaction and adjustment disorders—may play a role in the progression of different cancer types, little was known about how psychological distress around the time of a diagnosis of invasive cervical cancer impacts the cancer-specific mortality of patients diagnosed with the disease.

Study Methodology

The researchers utilized data from the Swedish Cancer Register on 4,245 patients diagnosed with invasive cervical cancer from January 1, 2002, to December 31, 2011. Data from the register was used to identify patients who had been clinically diagnosed with any of three psychiatric disorders: stress reaction and adjustment disorders, depression, or anxiety. The researchers also identified patients who experienced a highly stressful event, including the death of a family member, severe illness of a family member, divorce, or being between jobs, from 1 year before a cancer diagnosis and onward.

They calculated the hazard ratios (HRs) of cancer-specific mortality among the patients exposed to psychologic distress compared with unexposed patients. The data were controlled for socioeconomic characteristics and other known prognostic indicators, such as tumor and treatment characteristics.


The researchers found that patients exposed to psychological distress had an increased risk of cancer-specific mortality (HR = 1.33, 95% confidence interval [CI] = 1.14–1.54). The association was driven primarily by distress experienced within 1 year before or after the patients’ cancer diagnosis (HR =1.30, 95% CI = 1.11–1.52) but not thereafter (HR = 1.12, 95% CI, 0.84–1.49).

“These findings support the integration of psychological screening and intervention in the clinical management of patients with cervical cancer, particularly around the time of cancer diagnosis,” concluded the study authors.

Clinical Significance

“Patients receiving a cancer diagnosis are at an increased risk of several stress-related psychiatric disorders, such as depression, anxiety, and stress reaction and adjustment disorders,” said lead study author Donghao Lu, MD, PhD, a postdoctoral researcher in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Stockholm, in a statement. “Emerging evidence from both experimental and epidemiologic studies indicates that psychological distress might affect the progression of many cancer types.”

Dr. Lu is the corresponding author of this study.

Disclosure: Funding for this study was provided by the Swedish Cancer Society, the Swedish Research Council for Health, Working Life, and Welfare, and the Karolinska Institutet. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.