Volden and Conzen present

a complementary review of the influence selleck of glucocorticoid signaling on tumor progression through cell context-specific transcriptional networks (Volden and Conzen, 2012 1045). In the clinical context, disruption of HPA rhythms, as indicated by diurnal cortisol slopes, predicted early metastatic breast cancer mortality (Sephton et al., 2000). Sephton and colleagues, as reported in this volume, replicate those findings in a small sample of lung cancer patients followed for a median of 4 years from date of diagnosis (Sephton et al., 2012). Volden and Conzen foreshadow emerging interest in stress regulation of epithelial cancer biology through metabolic pathways and energy regulators such as insulin, leptin, ghrelin, and adiponectin (Cao and During, 2012 and Williams et al., 2009). Convergence of animal models and human correlative studies led Neeman and Ben-Eliyahu to identify catecholamine and prostaglandin-mediated immunosuppression as a perioperative risk factor for cancer recurrence and metastasis (Neeman and Ben-Eliyahu, 2012). The authors advance a theoretical model that captures the cumulative

risk and review mechanistic support for the use of pharmacological blockade of key mediators during the perioperative period. Sheridan and colleagues review the utility of a mouse Akt inhibitor model of repeated social defeat to elucidate neural-immune mechanisms in cancer (Powell et al., 2012). This review highlights the role of myeloid-derived cells in stress-primed inflammation, in tissue remodeling in non-immune and immune organs, and in support of behavioral states experienced as cancer-associated

sickness behaviors (see reviews in this volume by Bower and Lamkin, 2012, Costanzo et al., 2012 and Irwin et Methisazone al., 2012). The empirical paper by Madden et al. examines the impact of social isolation on breast cancer pathogenesis in adult severe combined immunodeficiency mice using a human breast cancer cell line known to express β-ARs (Madden et al., 2012). The results raise implications of mild vs. chronic stress exposure, timing of exposure during the life span of experimental animals, and the need to capture transient shifts in target cell populations. Further, the study supports the importance of myeloid-derived suppressor cells and stress-associated leukocyte recruitment as indicated by changes in macrophage populations in tumor and spleen, similar to that observed with social disruption (SDR) stress paradigms (Engler et al., 2004 and Powell et al., 2012). Bower and Lamkin identify two questions that direct contemporary research on cancer-related fatigue, i.e.