Mechanistic research illuminating connection among depression, stress, and survival.

I n a recent large study, patients with non–small-cell lung cancer who added beta blockers to radiotherapy showed better overall survival, distant metastasis– free survival, and disease-free survival than those receiving radiation alone. In this 12-year retrospective study of 722 patients, 155 who took beta blockers for hypertension and heart disease survived for a mean of 23.7 months, compared with 567 patients treated with radiotherapy alone, who lived for a mean of 18.6 months. This outcome represents a 22% survival benefit for those on beta blockers after adjustment for other factors, said author Annals of Oncology). " Our results suggest that the use of beta blockers during radiotherapy may help to prevent the formation of metastases in patients with non–small-cell lung cancer, " Gomez said. Although the underlying mechanism of metastasis is complex, it probably involves chronic stress conditions and prolonged exposure to stress hormones, such as nor-epinephrine, which stimulates tumor cell migration, Gomez observed. Beta blockers block the release of these stress hormones. " Our findings agree with results from previous studies suggesting that beta block-ers have a specific effect on the cascade of events that lead to metastases, " said study author Zhongxing Liao, MD, professor of radiation oncology, also at M. D. Anderson. " The fact that their use did not affect locoregional progression-free survival suggests that they affect the metastatic cascade rather than the primary tumor, " she said. This study mirrors other recent research, such as a large, population-based study of breast cancer patients in Scandinavia, in which patients took one of two beta-adr-energic blockers, propranolol or atenolol, 1 year before diagnosis. Those taking pro-pranolol were statistically significantly less likely to present with local tumor invasion, and they had lower probability of disease-specific mortality than matched nonusers (June 2013, Journal of Clinical Oncology). These studies are two of many recent clinical and epidemiological studies (January 2014, JNCI). Indeed, the National Cancer Institute is sponsoring several prospective trials in the US and Israel to test whether beta blockers can prevent recurrence and metastasis of colorectal, ovar-ian, and breast cancers after surgery, said Shamgar Ben-Eliyahu, PhD, principal investigator of one such study and professor of psychology at Tel Aviv University in Israel. These studies are examining the blockade of the postsurgical stress response, which suppresses immune function and fuels the growth of micrometasta-ses, Ben-Eliyahu said. Although research to determine whether such interventions targeting stress and depression can …