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Meta-analysis of stress-related factors in cancer

Nature Reviews Clinical Oncology volume 7, pages 1–2 (2010)Cite this article

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We wish to comment on the Chida et al.1 Review that investigated the contribution of stress-related variables to cancer incidence, survival time and mortality using a series of meta-analyses. Chida et al.1 reported significant associations for incidence of cancer (P = 0.005), survival time (P <0.001), and cancer mortality (P <0.001). The Review has attracted attention despite major flaws that we discuss below. Although the authors call for caution in interpreting these results due to evidence of a publication bias, we propose that the quality of the literature they review and their application of meta-analysis were inadequate and pose serious challenges to the validity of their conclusions.

The Review included results from a vast number of studies, most of which reported a null effect. The meta-analyses for incidence of cancer (142 studies; average sample size 87,062), survival time (157 studies; average sample size 418), and cancer mortality (50 studies; average sample size 93,059) involved large aggregate samples. Therefore, hazard ratios (HRs) and confidence intervals (CIs) are more informative than statistical significance because trivial effect sizes can nonetheless be highly significant with large sample sizes.2 Indeed, the CIs reported by Chida et al.1 for cancer incidence (HR 1.06, 95% CI 1.02–1.11) and survival (HR 1.03, 95% CI 1.02–1.04) barely excluded 1.0 and were thus close to non-significance. Such trivial effect sizes do not typically generate much interest in the larger epidemiological community, especially when authors acknowledge statistical indications of a publication bias, as was the case in this Review.

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Authors and Affiliations

  1. Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, 19104-2646, PA

    James C. Coyne & Steven C. Palmer

  2. Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands

    Adelita V. Ranchor

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  1. James C. Coyne
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  2. Adelita V. Ranchor
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  3. Steven C. Palmer
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Correspondence to James C. Coyne.

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Coyne, J., Ranchor, A. & Palmer, S. Meta-analysis of stress-related factors in cancer. Nat Rev Clin Oncol 7, 1–2 (2010). https://doi.org/10.1038/ncponc1134-c1

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