Systematic Review of the Literature on Associations Between Symptoms, Stress, Resilience, and Epigenetic Aging in Patients With Cancer.
Abstract
Background
Cancer and its treatments can have long-term adverse effects that may accelerate aging and worsen symptom burden. The cognitive and behavioral strategies that patients utilize to adapt to their environment and respond to stress may influence inter-individual variability in aging and symptom burden. This systematic review summarizes the relationships between symptoms, stress, resilience, and epigenetic aging in oncology patients and identifies knowledge gaps.
Methods
A search of relevant databases was done from January 2000 to May 2026. Studies were included that examined DNA methylation patterns to predict biological age using algorithms known as epigenetic clocks in adults with cancer. A qualitative synthesis of the quantitative studies is reported.
Results
Of the 10 studies included in this review, a total of nine different methods were used to predict epigenetic age. The most common methods were the Levine, Horvath, and Hannum clocks. Nine studies reported on associations between symptoms and epigenetic age acceleration; one study reported on an association between stress and epigenetic age acceleration; and one study reported on an association between resilience and epigenetic age acceleration.
Conclusion
More longitudinal studies are needed to validate these findings and investigate variations by epigenetic age estimate, timing of assessment, cancer type, and stage of disease. Studies are needed to evaluate the role of stress and resilience in mediating/moderating the relationships between epigenetic age acceleration and symptoms in patients with cancer. IMPLICATIONS FOR NURSING PRACTICE A subset of patients with cancer who develop more severe fatigue, pain, sleep disturbance, peripheral motor neuropathy, cognitive, depressive, and/or anxiety symptoms may experience epigenetic age acceleration. SYSTEMATIC REVIEW REGISTRATION This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD42024545895).