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Cancer-related accelerated ageing and biobehavioural modifiers: a framework for research and clinical care

Nature Reviews Clinical Oncology volume 19, pages 173–187 (2022)Cite this article

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Abstract

A growing body of evidence indicates that patients with cancer who receive cytotoxic treatments (such as chemotherapy or radiotherapy) have an increased risk of accelerated physical and cognitive ageing. Furthermore, accelerated biological ageing is a suspected driving force behind many of these observed effects. In this Review, we describe the mechanisms of biological ageing and how they apply to patients with cancer. We highlight the important role of specific behavioural factors, namely stress, sleep and lifestyle-related factors such as physical activity, weight management, diet and substance use, in the accelerated ageing of patients with cancer and cancer survivors. We also present a framework of how modifiable behaviours could operate to either increase the risk of accelerated ageing, provide protection, or promote resilience at both the biological level and in terms of patient-reported outcomes.

Key points

  • Cancer and its treatments are thought to promote accelerated biological ageing, leading to adverse cognitive, behavioural and functional outcomes in cancer survivors.

  • Modifiable host-specific factors are known to affect ageing biology in individuals without cancer, including psychosocial stress, poor sleep, physical inactivity, obesity, and tobacco and alcohol use.

  • Behavioural interventions and/or modifications targeting these host factors might directly alter biological ageing processes in patients with cancer and cancer survivors, thereby improving both healthspan and lifespan.

  • We propose that these host factors be considered in models of cancer-related age acceleration and that interventions designed to reduce stress, improve sleep health, increase physical activity, manage weight, and/or reduce alcohol and tobacco use be investigated as promising approaches to address accelerated ageing in this context.

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Fig. 1: Model of biobehavioural modifiers of cancer-related accelerated ageing.
Fig. 2: Neuroendocrine-mediated pathways driving biological ageing following activation of the stress response.
Fig. 3: Interventions proposed to inhibit the effects of cancer treatments on biological ageing and to modify long-term physical and cognitive health.

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Acknowledgements

The work of J.E.C. was supported in part by the American Cancer Society Research Scholars grant 128660-RSG-15-187-01-PCSM and the National Cancer Institute at the National Institutes of Health grant R01CA237535 and R35CA197289. The work of J.E.B. was supported in part by the National Cancer Institute at the National Institutes of Health grant R01CA237535 and the Breast Cancer Research Foundation. The work of P.A.G. was supported by the Breast Cancer Research Foundation and the author notes that she serves on the Scientific Advisory Board of the Breast Cancer Research Foundation.

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Authors and Affiliations

  1. Norman Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behaviour, University of California, Los Angeles, CA, USA

    Judith E. Carroll & Julienne E. Bower

  2. Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA

    Judith E. Carroll & Julienne E. Bower

  3. Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA

    Judith E. Carroll, Julienne E. Bower & Patricia A. Ganz

  4. Department of Psychology, University of California, Los Angeles, CA, USA

    Julienne E. Bower

  5. Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA

    Patricia A. Ganz

  6. Department of Medicine (Hematology-Oncology), David Geffen School of Medicine, University of California, Los Angeles, CA, USA

    Patricia A. Ganz

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Carroll, J.E., Bower, J.E. & Ganz, P.A. Cancer-related accelerated ageing and biobehavioural modifiers: a framework for research and clinical care. Nat Rev Clin Oncol 19, 173–187 (2022). https://doi.org/10.1038/s41571-021-00580-3

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