Researchers found no difference between upbeat, less positive patients
MONDAY, Oct. 22 (HealthDay News) -- Neither positive nor negative emotional states predict how long a person with cancer will survive, a new study finds.
University of Pennsylvania researchers say that among head and neck cancer patients, emotional health -- good or bad -- is not an independent factor affecting prognosis.
"We anticipated finding that emotional well-being would predict the outcome of cancer. We exhaustively looked for it, and we concluded there is no effect for emotional well-being on cancer outcome," said study author and University of Pennsylvania psychologist James Coyne. "I think [cancer survival] is basically biological. 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."
The study, expected to be published in the Dec. 1 issue of Cancer, culled data from almost 1,100 patients enrolled in two phase III clinical trials for new head and neck cancer treatments.
The patients completed questionnaires about their attitude and social networks at the beginning of the study and at follow-up. The questionnaire included five questions to assess emotional well-being, including such items as "I am sad" and "I am losing hope in my fight against my illness."
By the end of the five-year study, 646 patients died. When the data was analyzed, the researchers found that emotional status had no effect on the course of the cancer or the patient's survival.
Although there is no evidence that psychotherapy or support groups contribute to the chance of survival, Coyne said that if cancer patients need mental health help to improve their quality of life, they should pursue it.
Study co-author Dr. Benjamin Movsas agreed, saying that quality of life may indeed be a factor in a patient's survival of cancer, but it is a much bigger concept than mood and attitude.
"In a separate study, we found that single males with head and neck cancer appeared to be at risk for lower survival... and in another study, we found single males with cancer had among the lowest quality of life," said Movsas, who is chairman of radiation oncology at Henry Ford Hospital in Detroit.
About 40,000 new cases of head and neck cancer are diagnosed each year, and about 11,000 people die from these cancers annually, according to the American Cancer Society.
The role of the patient's attitude in cancer treatment has been in debate for years. This is not the first study to assess whether emotional state could affect the course of cancer. However, this study had a larger number of deaths than some other studies had enrollees, the researchers noted, allowing them greater control over issues of chance that could affect the study results.
One advantage to working with people in a clinical trial, Coyne said, is knowing that they are all receiving the same treatment.
But positivity or negativity are not the issue, suggested Dr. David Spiegel, associate chairman of psychiatry and behavioral sciences at Stanford University School of Medicine in California. What matters is the way in which a cancer patient approaches the stresses in his or her life, Spiegel said.
"The authors vastly overstate the quality of their data and the findings," said Spiegel. "They used a subscale of a quality-of-life measure which is hardly a reliable measure of depression and provides, by definition, limited variance in mood, making it, by design, difficult to show a relationship with any other variable."
Spiegel also noted that head and neck cancers generally have a "very poor prognosis," are not hormone-sensitive, and usually require serious surgery and radiotherapy -- all of which has social and psychological consequences.
"Our research shows that it is not a positive attitude but rather facing and dealing well with the ups and downs of life with cancer that is, at the least, psychologically helpful," Spiegel said.
But an Australian study released in the February issue of Cancer showed similar results for lung cancer patients. Patients in that study also completed questionnaires about their outlook before treatment and after treatment.
As with the current study, the Australian research team found no relationship between attitude, positive or negative, and outcome.
Another study released in the Nov. 1 issue of the British Medical Journal analyzed data from 26 studies of emotional outlook and cancer survival and came to the same conclusion: A positive outlook may be a good thing in general but has no impact on cancer outcomes. The same was true for negativity.
But more research is needed, argued Spiegel. The connection between true depression and the course of cancer is still not well understood.
"Patients in my support group joke, 'Am I living longer yet?' They grieve deaths when they occur, but feel they grow stronger doing so," said Spiegel. "They joke about the prison of positive thinking. The connection between mood and cancer is not about 'positive thinking,' it is about managing the very real stressors of life-threatening illness."
Another expert said he wasn't surprised by the Pennsylvania findings.
"People are more likely to find this news a relief than a disappointment," said Dr. Michael Fisch, an associate professor of gastrointestinal medical oncology at the University of Texas M.D. Anderson Cancer Center, in Houston.
Survival depends on the location of the cancer, the risk factors for the cancer, and how advanced the cancer is when it's diagnosed, said Fisch.
According to Fisch, who treats head and neck cancer patients in Houston, survival also has more to do with access to health care and the biology of the cancer in question than attitude. Good social support and a spiritual sense of something greater than yourself are also beneficial, said Fisch.
Fisch pointed out that probably only 5 percent of head and neck cancer patients ever enter a phase III clinical trial, and those that do are likely to already have more social and medical support than their peers. In other words, they came into the study with an advantage which would make data based on their reported attitudes difficult to generalize to other cancer patients.
Fisch favors a concept he calls "rooting styles" -- comparing the way people approach cancer with the way they root for a sports team. Some are diehard, never-say-never fans, and others may allow for the possibility of losing a game or a season, but both fans are backing the same team.
"Some people have a style where they are optimistic. Some have a style where, if you ask them what they think the outcome will be, they are less certain. They have a coping style that is not a positive-attitude coping style, but it keeps them edgy and works for them," said Fisch.
In fact, Fisch added, trying to encourage a person with a less positive way of talking about their cancer to think more positively would just cause them more stress. That's what he calls the "tyranny of the guilt systems," where others imply that a patient has some mental control over their cancer's outcome.
Clashes between different rooting systems can become a challenge when families or couples have different styles, Fisch said. The key is to find what works for the patient and support that.
For advice on talking to someone diagnosed with cancer, head to the American Cancer Society.
SOURCES: James Coyne, Ph.D., department of psychiatry, University of Pennsylvania Health System, Philadelphia; Michael Fisch, M.D., associate professor, gastrointestinal medical oncology, the University of Texas M.D. Anderson Cancer Center, Houston; Benjamin Movsas, M.D., chairman, radiation oncology, Henry Ford Hospital, Detriot; David Spiegel, M.D., Jack, Lulu and Sam Wilson Professor, School of Medicine, and associate chairman of psychiatry and behavioral sciences, Stanford University School of Medicine, Stanford, Calif.; Dec. 1, 2007, Cancer
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