Allostatic Load in Cancer: A Systematic Review and Mini Meta-Analysis

Abstract

Background: Individuals with cancer experience stress throughout the cancer trajectory. Allostatic load (AL), a cumulative multi-system measure, may have a greater value in stress assessment and the associated biological burden than individual biomarkers. A better understanding of the use of AL and its operationalization in cancer could aid in early detection and prevention or alleviation of AL in this population. Purpose: To consolidate findings on the operationalization, antecedents, and outcomes of AL in cancer. Methods: Seven databases (CINAHL, Ovid MEDLINE, Web of Science, APA PsycInfo, Scopus, Embase, and Cochrane CENTRAL) were searched for articles published through April 2020. The NIH tools were used to assess study quality. Results: Twelve studies met inclusion criteria for this review. Although variability existed in the estimation of AL, biomarkers of cardiovascular, metabolic, and immune systems were mostly used. Associations of AL with cancer-specific variables were examined mostly utilizing population-databases. Significant associations of AL with variables such as cancer-related stress, positive cancer history, post traumatic growth, resilience, tumor pathology, and cancer-specific mortality were found. Mini meta-analysis found that a one-unit increase in AL was associated with a 9% increased risk of cancer-specific mortality. Conclusion: This review reveals heterogeneity in operationalization of AL in cancer research and lack of clarity regarding causal direction between AL and cancer. Nevertheless, AL holds a significant promise in cancer research and practice. AL could be included as a screening tool for high-risk individuals or a health outcome in cancer. Optimal standardized approaches to measure AL would improve its clinical utility.

Disparities in Breast Cancer Associated With African American Identity

“…44 In cancer, association was observed between allostatic overload and cancer-related stress, resilience, and cancer-specific outcomes. 45 Attempts at reducing allostatic overload in patients with breast cancer have been shown to improve survivors' quality of life. 46 Allostatic overload has been closely associated with race, irrespective of poverty level.…”

Marital Status, Living Arrangement, and Cancer Recurrence and Survival in Patients with Stage III Colon Cancer: Findings from CALGB 89803 (Alliance)

“… 35 , 36 In the context of cancer, chronic stress may result in impaired tumor immune surveillance 37 or DNA damage 38 ; indeed, a higher allostatic load has been associated with increased overall cancer-specific mortality. 39 , 40 Among patients with breast cancer, it has recently also been correlated with worse chemotherapy completion rates. 41 Although no studies to date have examined the role of allostatic load in CRC outcomes, our finding that disruptions in or loss of relationships—as is the case in divorce, separation, and widowhood—are associated with worse survival, rather than never having been married, may be supportive of this notion.…”

Examining allostatic load, neighborhood socioeconomic status, symptom burden and mortality in multiple myeloma patients

“…Study findings of an association between AL and overall survival are consistent with prior studies on AL in other cancer patients [ 17 ]. Specifically, previous studies suggest increasing AL is associated with worse overall and cancer-specific survival [ 16 , 17 ]. Although, the relationship between AL and PFS did not reach statistical significance the direction of the relationship is consistent with the relationship of AL to survival in other oncologic studies [ 16 , 17 ].…”

“…Elevated AL has been linked to SDH such as low socioeconomic status and educational attainment [ 12 – 15 ]. Moreover, increased AL has been associated increased disease-specific and overall mortality in cancer patients [ 16 , 17 ]. Notably, individual components of AL have been independently associated with tumorigenesis, mortality, and patient-reported adverse events [ 18 – 20 ].…”