Is chronic stress to blame for the British royal family's recent cancer diagnoses?
Key Takeaways
Several members of the British royal family have been diagnosed with cancer so far this year, and chronic stress may have contributed.
Although evidence is mixed, there is some research suggesting direct and indirect explanations for a link between chronic stress and cancer.
For patients who are complaining about high levels of stress, you can refer them to a number of possible ways to lower them, including consumption of certain vitamins, supplements, and foods; physical activity; or a visit with a mental health professional.
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.[][][]
While it is impossible to pinpoint the exact cause of any of these malignancies, the cluster within members of the royal family may lead some to wonder whether the stress of carrying out official duties and constant public scrutiny could be contributing.
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.
A study in SSM – Population Health, for one, established a connection between a high allostatic load—a measure of the effects of chronic stress on the body that appears to be enhanced in racial/ethnic minorities—and a greater risk of cancer death.[]
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.[] 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 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.[]
A stress response may release norepinephrine, a hormone that can induce angiogenesis and metastasis and activate neutrophils. Neutrophils may ease tumor growth by shielding the masses from the immune system or by reactivating dormant cancer cells.
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.[]
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.[] 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.[]
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.[] 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.[]
What this means for you
It is unclear whether the cancer diagnoses among members of the British royal family are related to chronic stress, but there is evidence that such an exposure can precipitate or worsen malignancies through direct and indirect mechanisms. For your patients, you can suggest possible ways to lower stress levels that can include vitamins, supplements, and foods, emotional and social support, physical activity, meditation, yoga, and an adequate amount of sleep.