Dounya Schoormans

Psychological symptoms often point to a host of disrupted biological processes”

Science Works 4 min Femke Trommels

Our moods and emotions are to a large extent driven by biological processes in our bodies. Cancer wreaks havoc on these processes, thus increasing the risk of such psychosocial symptoms as anxiety and depression taking hold. Assistant professor Dounya Schoormans studies which biological mechanisms take the lead in this interaction between body and mind. “By showing the biology behind the symptoms, I hope we can help people more effectively and free them of the stigma attached to chronic psychological problems after cancer.”

Biological processes are often behind symptoms such as depression, anxiety, and fatigue. “Biopsychologists try to understand which biological mechanisms are involved in which symptoms. Or in other words, why does someone become depressed?” Dounya relates. “Before attempting to answer why someone has certain symptoms, we first identify which symptoms are prevalent and try to determine who exactly has these symptoms.”

Symptom clusters

So which symptoms are prevalent? “The problem is that it is not one single thing: symptoms frequently coexist and interfere with one another. We refer to that as symptom clusters. If you are in pain, you don’t sleep very well. If you become fatigued, that will affect your mood. If anxiety leads to inactivity, you may feel even worse or be in more pain.

Three biological mechanisms

To find out why certain symptoms are prevalent, it may help to better understand the biological mechanisms involved in these symptom clusters. Together with colleagues, Dounya is studying three mechanisms that play an important role.

The first mechanism is inflammation: the inflammatory response. Cancer very cleverly outwits the immune system, evading and disrupting it. Undergoing major treatment like chemotherapy further weakens the immune system. The substances that become disrupted contribute to such symptoms as fatigue and depression.

The second mechanism – the kynurenine pathway – is the object of highly innovative research. This is about a cascade reactions, a metabolic pathway, whereby a metabolite called tryptophan is converted into all kinds of other substances. This process is related to immune activation. Since we know that cancer disrupts the immune system, it is likely that the kynurenine pathway is involved in developing certain symptoms and/or in their persistence.

The third mechanism accelerates cell aging, which in itself is a natural process as one grows older. Everyone has a calendar age and a biological age. But cancer speeds up this process, causing body cells to age more quickly. This can bring on age-related ailments sooner: poorer quality of sleep and cardiovascular disease. The cancer might even come back.

As a result of accelerated cell aging, age-related ailments kick in sooner


“The trouble is that these biological processes remain active long after treatment has ended. As a result, symptoms can persist for a very long time. Patients themselves, the people around them and society at large expect cancer survivors to be cured as soon as the cancer has been successfully treated, and patients may end up feeling lost and misunderstood. I hope my research will show how much is happening in patients’ bodies. It is my hope that better knowledge will make cancer survivors feel better understood and that it will see the end of stigmatizing ideas about cancer survivors.”

Dounya Schoormans

Hopefully this will see the end of stigmatizing ideas about cancer survivors who experience chronic symptoms

Dounya Schoormans

Pieces of the puzzle

“Collecting and combining data is a complex puzzle. In my study, I try to link symptoms to the biomarkers of the three mechanisms. We want to link those outcomes to certain interventions. Five studies are underway at the moment, in which we collect information from various sources of people who have been diagnosed the breast, colon, thyroid, cervical and blood cancer. We do so at three moments: directly after diagnosis and before treatment, one year after diagnosis (often that is after the first treatment has ended), and two years after diagnosis. We ask patients about the symptoms they experience and about their diet. They also wear a Fitbit so we have information of their physical activities. We also collect blood samples three times so we can measure the biomarkers. In addition to patients, we also study healthy people for comparison.”

Ultimate dream

“Oncology research is heavily geared toward organ-specific tumors. The study on biomarkers also takes place in this context. For instance, we study fatigue in people with colon cancer, but it would be interesting to look at the bigger picture for particular symptoms. Are there specific symptom clusters that are frequently reported by patients, irrespective of the type of cancer? Who, across the board, are most at risk? Who should be monitored more closely? What symptom clusters belong to what biological processes and why? Using this information, we can offer targeted interventions and help patients more effectively. That is my ultimate dream.”

About the research

As a researcher, Dounya Schoormans is affiliated to PROFIEL, a collaboration between the research group of Medical and Clinical Psychology of the Tilburg School of Social and Behavioral Sciences (TSB) and the Netherlands Comprehensive Cancer Organisation (IKNL).

Within PROFIEL, we work together with hospital doctors and nurses and the Dutch Federation of Cancer Patient Organizations (NFK). Various studies are being conducted into the impact of cancer treatments on patients and their loved ones. Treatment can have a broad impact: physically (pain, cardiovascular problems), socially (inability to keep up), financially (job loss, inability to get a mortgage), psychosocially (fatigue, depression, anxiety). PROFIEL’s focus is on increasing the quality of life of cancer survivors, of people living with cancer and of their loved ones. “In our research group, everyone tries to solve their piece of the puzzle with a view to improving people’s lives.”

In our research group everyone tries to solve a piece of the puzzle, with the goal to make people feel better. 

More research

Within Tilburg University, a group of enthusiastic and committed researchers who investigate the psychosocial consequences of cancer. They work together to gain insight in the psychological and biological processes behind, for instance, fatigue, anxiety, and pain.

Discover research on cancer at Tilburg University

Publication date: 3 February 2022