Studies Find The Way You Cope Doesn’t Influence Cancer Survival or Recurrence
According to the American Cancer Society, more than 8.9 million Americans alive today have faced a diagnosis of cancer. Many patients and physicians have long shared the view that a person’s mental attitude could affect his or her chances of surviving cancer. Numerous studies have examined the effect of a fighting spirit, denial or avoidance, helplessness/hopelessness, acceptance and fatalism, and other coping mechanisms on cancer survival. For instance, a small study done in 1979 found that cancer patients with a “fighting spirit” had a longer survival from breast cancer, while other studies from the 80’s and 90’s have found that the negative styles of coping (like “helplessness/hopelessness”) predict a poor outcome from cancer.
Several biological mechanisms have been proposed for this effect, including immunological and neuroendrocrine mechanisms. However, the evidence has been conflicting about whether psychological factors (be they positive or negative) have an influence on cancer. A new review published in the November 9, 2002 issue of The British Medical Journal , suggests that, overall, the evidence is weak regarding a link between psychological coping and cancer outcomes.
About the Study
Researchers from England did a review of 29 studies from around the world, which all examined the association between coping styles and survival or recurrence of cancer. To be included for review, the studies had to follow a group of patients over a set period of time and document cancer mortality survival, or recurrence as outcomes.
The reviewers collected information from each study concerning the number of study participants, style of coping, site of cancer, length of follow-up, adjustments made for confounding variables, and outcomes. The researchers made comparisons between studies based upon the type of coping strategy, the study size, and study quality.
The researchers found that there was little evidence supporting the belief that psychological coping styles have an important influence on survival of people with cancer. When looking at the different coping strategies, there did not appear to be conclusive evidence that either positive or negative coping had any influence on cancer outcome. For instance, in looking at the 12 studies that examined the influence of helplessness and hopelessness, 4 small studies reported these feelings negatively affected survival, five studies were inconclusive, and 3 others were so methodologically flawed that no conclusion could be reached. Similar inconsistencies were noted in the other coping mechanism categories.
About a third of the studies included in this review did not adjust for potential confounding variables. Other studies adjusted for a variety of things including age, social class, marital status, smoking, education, medical history, and numerous other factors. Most of the 29 studies were small (average size of 125 participants) and only thirteen (45%) met the researchers’ strict standards of study quality. No association between study quality and study outcome was observed.
Although these results are interesting, there are a number of limitations to this study. First, because the studies exhibited considerable variability in design and quality, comparisons between them are imperfect at best. Second, there is always a chance that the researchers missed a number of positive studies that did not make it into the literature, a phenomenon known as “publication bias”. Although this may be true, it is more likely that those studies failing to show an association between coping strategies and cancer outcomes were not published. Third, the measures used to assess the various coping strategies may not have properly captured the true nature of the subjects’ emotional state. It may be that other, as yet unmeasured, psychological reactions do actually influence cancer survival and recurrence.
How Does This Affect You?
Does this mean that those diagnosed with cancer shouldn’t bother joining support groups, talking about their illness, or finding constructive ways to cope? Certainly not! Regardless of their (as yet) unproven influence on cancer survival and recurrence, psychological factors and coping mechanisms can have a great influence on mental health, overall well-being, and other conditions influenced by mind/body connections. Anger, hopelessness, withdrawal and other negative emotions that last for more than a couple weeks can be a sign of anxiety or depression—two illnesses that can have serious negative health consequences.
Support groups in particular have the added benefit of providing patients and their families with a source of information on new treatments, ways to deal with symptoms, and new friends to compare notes and commiserate with. The American Cancer Society recommends the following helpful coping skills for those with cancer:
- Look for more information when problems arise or you hear bad news
- Talk with others and share your concerns when facing a problem
- Try to find the positive in even difficult situations
- Try not to think about your illness every day and keep busy to distract yourself from being sick
- If reliable information indicates you need to change treatment, do it without delay
- Try to use your cancer as a way to reexamine your life, while continuing to enjoy people and activities around you
American Cancer Society
National Cancer Institute
Petticrew M, Bell R, Hunter D. Influence of psychological coping on survival and recurrence in people with cancer: systematic review. The British Medical Journal . 2002;325:1066-1069.
Last reviewed Nov 14, 2002 by
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