Chronic psychological stress and gastric cancer: bidirectional associations, biological mechanisms, and clinical implications-a narrative review.

BACKGROUND AND

OBJECTIVE

Gastric cancer (GC) remains one of the major malignancies worldwide, and its development and progression are shaped by the complex interplay of tumor-related, patient-related, and psychosocial factors. Chronic psychological stress, particularly anxiety and depression, may be associated with GC susceptibility, treatment tolerance, survival-related outcomes, and quality of life. This narrative review aims to synthesize current GC-specific evidence on the bidirectional relationship between chronic psychological stress and GC.

METHODS

Targeted searches of PubMed, Web of Science, and relevant reference lists were conducted up to February 2026. Search terms included "gastric cancer", "chronic psychological stress", "depression", "anxiety", "psychological distress", "β2-adrenergic receptor", "hypothalamic-pituitary-adrenal axis", "inflammation", "immune escape", "microbiota", "gut-brain axis", and "supportive care". Priority was given to GC-specific clinical, epidemiological, mechanistic, and interventional studies.

KEY CONTENT AND FINDINGS: Current evidence suggests a clinically meaningful but still evolving bidirectional association between chronic psychological stress and GC. Anxiety and depression are common in patients with GC and may affect treatment tolerance and survival-related outcomes. Mechanistic studies further suggest that chronic psychological stress may be linked to GC progression through neuroendocrine dysregulation, oxidative-inflammatory amplification, immune escape, hormonal and metabolic remodeling, and microbiota-related pathways. Conversely, GC itself may act as a persistent stressor that aggravates anxiety and depressive symptoms.

CONCLUSIONS

Chronic psychological stress should be considered a clinically relevant factor in GC management. Further prospective clinical studies, integrated mechanistic investigations, and multidisciplinary intervention trials are needed to clarify causality and determine whether stress-informed management can improve both psychological and oncologic outcomes.