NOVEMBER 15-30, 2007


Good cheer's no cure for cancer: study

Experts face off over positive thinking's
impact on CA survival

Lance Armstrong may have a lot to answer for, if a new study challenging the notion that a positive attitude can cure cancer is anything to go by. The study will appear in December in the journal Cancer.

We hear so many stories about heroes like Mr Armstrong facing up to their cancer these days with strength and good cheer, that oncologists refer to it as the "prison of positive thinking." That phrase describes the pressure which faces a patient newly diagnosed with cancer, who not only has to deal with possible imminent death, but also feels obliged to show everyone how strong and cheerful they are about it.

Well the pressure is now off. Psychologist James Coyne, PhD, of the University of Pennsylvania, and colleagues conclude that emotional well-being had no influence on the survival of 1,093 head and neck cancer patients.

In popular culture, we are told how people are battling cancer with their strength of will. The obvious implication is that strength of will improves their chances of winning the battle.

The obvious flip-side implication is that weakness, self-pity or depression actually reduce patients' chances of surviving cancer. So those with negative feelings about it all - a natural enough response to cancer - end up feeling doubly bad, because they must worry that their worrying is making them sicker.

At the extreme, patients can even blame their mental state for the development of their cancer. A 2001 survey of nearly 400 Canadian breast cancer patients by University of Toronto researchers found that 42% cited stress as one of the main causes of their disease, considerably more than blamed either genetic or environmental causes.

"I think cancer survival is basically biological," said Dr Coyne. "Cancer patients shouldn't blame themselves - too often we think if cancer were beatable, you should beat it. You can't control your cancer. For some, this news may lead to some level of acceptance."

Dr Coyne's study is by no means the first to address this question, but it's certainly the biggest to home in ruthlessly on survival, dismissing surrogate endpoints that the authors believe have muddied the waters in previous research.

At the study's outset, the 1,093 subjects completed a validated questionnaire often used to measure quality of life in cancer, the Functional Assessment of Cancer Therapy-General (FACT-G). It includes five questions that measure emotional well-being.

Of these patients, 646 died during the course of the study, which is considerably more deaths than the overall number of subjects in previous trials. After controlling for tumour size and known socioeconomic variables, the researchers found that "no statistically significant univariate or multivariate effects were observed for emotional well-being." These latest findings, Dr Coyne said, "may not end the debate, but they provide the strongest evidence to date."

Writing in the journal Psycho-Oncology this month, Dr Coyne suggested that ending the debate might be a good idea: "Belabouring the argument that psychotherapy promotes survival is not scientifically justified and risks slighting the important benefits that psychological interventions may have for some patients in terms of reducing their distress."

Dr Coyne was particularly critical of a landmark 1989 Lancet study by a leader in the field, Dr David Spiegel of Stanford University, which he said became a gold-standard study despite what he considers an underpowered sample and a "less appropriate analytic technique."

He didn't stop there: "Unsubstantiated claims about benefits for survival, however well intended and hopeful, are medical claims and just as objectionable as when unsubstantiated claims are made about herbs or coffee enemas as cures of cancer."

Ouch. Dr Spiegel, needless to say, isn't taking that lying down. "Dr Coyne was a solid depression researcher who is a newcomer to this field and is trying to establish himself by attacking me and others," he told NRM. "He has crossed the line of polite debate, and I've actually had to make some complaints."

Head and neck cancer, says Dr Spiegel, is a poor choice to search for emotional factors impacting survival, because it's known to have a minimal hormonal component, and hormones are the main mechanism by which emotions are postulated to effect survival.

Dr Spiegel pointed to a study in September's Journal of Psychosomatic Research which found that women with recurrent breast cancer who reported traumatic events in their lives had seen average remissions less than half as long as those who reported stress-free lives. The weight of research is still balanced between positive and null results, he said. He himself is currently conducting research aimed at replicating his famous 1989 results.

Dr Coyne and his allies had simplified and mischaracterized his findings, said Dr Spiegel. "Talk of a 'prison of positive thinking' is misplaced. Looking after patients' emotional well-being has never been about telling patients to 'put on a happy face'. There is more than one kind of positive thinking in cancer: no-one advocates encouraging blind optimism that you'll be cured. The patients who benefit from their mental attitude are those who find the strength to face the possible bad consequences, those who learn to live with the possibility of death."



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