Case Study: Psychosocial Stress, Immune Suppression, and Stress-Induced Cancer Recovery

According to Antoni & Dhabhar (2019), chronic psychosocial stress can greatly influence immune system functioning in cancer patients, compromising the body’s ability to detect and eliminate cancer cells.

Jennifer’s stage II breast cancer diagnosis, along with her ongoing chemotherapy treatments, combined with her increased psychosocial stress impacting her anxiety, energy levels, and sleep patterns, can dysregulate essential neuroendocrine pathways and immune functions (Antoni & Dhabhar, 2019).

Immune Suppression

Chronic stress activates both the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis, which releases a cascade of immune-suppressing stress hormones, including norepinephrine (NE), epinephrine, dopamine, and cortisol (Hong et al., 2021). These neuroendocrine responses limit protective immune functions and increase suppressive and inflammatory pathways (Antoni & Dhabhar, 2019; Hong et al., 2021). 

Elevated cortisol levels can suppress healthy T-cell function, natural killer (NK) cells, and dendritic cells, as well as cytokine production, which are essential for immunosurveillance and the elimination of cancer cells (Antoni & Dhabhar, 2019; Hong et al., 2021). This greatly reduces the body’s defense against tumor growth, especially in patients with ongoing psychological overwhelm.

Additionally, chronic stress increases immunosuppressive cells, including regulatory T cells and myeloid-derived suppressor cells (MDSCs), as well as tumor-related macrophages, all of which inhibit the body’s ability to adequately respond to tumor cells (Antoni & Dhabhar, 2019). Furthermore, chronic stress reduces interferon production, inhibits Th1- and CTL-mediated immunity, and increases the destruction of immunosuppressive cells, compromising Jennifer’s defense against tumor cells and long-term cancer recovery (Hong et al., 2021).   

Stress and Sleep Hygiene

Jennifer’s sleep disturbances play a major role in her recovery process. According to Irwin (2015), when the HPA and SNS are activated, glucocorticoids and catecholamines are released into the body. This change in hormonal balance can disrupt the regulation of adaptive and innate immunity and healing, thereby suppressing the body’s ability to respond to tumor cells (Irwin, 2015). Glucocorticoids slow the transcription of antiviral and inflammatory genes that support immune cell activity, while chronic SNS activation disrupts a healthy immune response and increases a proinflammatory state (Irwin, 2015). When the body experiences chronic inflammation, it can disrupt healthy immune surveillance and contribute to tumor growth (Irwin, 2015). 

Sleep disturbances are linked to psychological conditions such as anxiety and depression, further complicating Jennifer’s natural healing abilities. Irwin (2015) concludes that poor sleep hygiene disrupts neuroendocrine regulation, interferes with the development of a regular sleep pattern, increases a bidirectional feedback loop, and influences both physiological and psychological stress. 

Interventions

Antoni & Dhabhar (2019) found that cognitive-behavioral management (CBSM) can help reduce chronic stress, normalize cortisol and other hormonal patterns, and repair immunity-improving markers. Additionally, Hong et al. (2019) found that β-adrenergic receptor blockers, such as propranolol, reduce tumor progression while improving responsiveness to chemotherapy. 

For Jennifer, addressing both psychosocial stress and improving her sleep hygiene are critical for healthy immune functioning and mental well-being. A medication such as propranolol can help stabilize her physiological response to the chemotherapy to help her feel more regulated in her body. From there, targeted behavioral interventions focused on building healthy sleep patterns and on psychosocial responses to stress can help regulate her immune response, reduce inflammation, and improve treatment outcomes and long-term recovery.  

References

Antoni, M. H., & Dhabhar, F. S. (2019). The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer, 125(9), 1417-1431. https://doi.org/10.1002/cncr.31943

Hong, H., Ji, M., & Lai, D. (2021). Chronic stress effects on tumor: Pathway and Mechanism. Frontiers in Oncology, 11, 738252. https://doi.org/10.3389/fonc.2021.738252

Irwin, M. R. (2015). Why sleep is important for health: A psychoneuroimmunology perspective. Annual Review of Psychology, 66, 143–172.  https://doi.org/10.1146/annurev-psych-010213-115205

— First published for Saybrook University, MBM 56481 Psychophysiology of the Human Stress Response, July 13, 2025.