“God helps those who help themselves.”
-Something that sounds like Truth but fortunately isn’t mentioned in any religious text
“I’m gonna beat this thing again, Doc! I just know it!”
Over the course of several years, I helped care for a man with a very rare cancer that recurred over-and-over. With each new tumor, he became more focused on beating the disease and despite the repeated setbacks, he remained eternally positive. He spent hours researching every available experimental treatment. He trekked from center to center for therapy. His determination was inspirational. Despite the intensity of his effort, he eventually lost his battle and died. His well-attended visitation and funeral were testimonies to his remarkable life, his outgoing personality and the respect everyone had for his determination.
My super-positive patient told me more than once that his attitude was helpful. “It’s why I’m still alive,” he said. His intensity prompted me to ask: How does attitude affect survival? If a patient tries “hard enough,” can cancer be controlled?
It’s a difficult issue. It is wonderful being with people who are optimistic. As a physician, patients who are positive in the face of terrible adversity are inspirational. Of course, many patients dealing with cancer are devastated both physically and emotionally. With the tobacco-related cancers for which I care, many of my patients carry an extra burden of guilt.
Memorial Sloan-Kettering Cancer Center Psychiatrist Jimmie Holland, MDworks with many patients who carry this burden. She refers to a patient or family’s insistence that he or she maintain a positive attitude at all times as “The Tyranny of Positive Thinking.”
What does research tell us? A positive attitude in cancer patients does not prolong life. In a study of over 1000 head and neck cancer patients, there was no association between the scores of Emotional Well-Being and cancer survival. (Coyne, Cancer 2007, 110:2568-2575.) Similarly, a study of Canadian women with metastatic breast cancer randomized to receive group psychosocial support did not survive any longer than women who were not in a support group, although they had an improved mood and some experienced less perceived pain (Goodwin, NEJM 2001 345:1719-1726).
So, is this good news or bad? It depends on your interpretation. From my vantage point, the finding that there is no correlation between attitude and survival serves as a gift for our patients and for us. Allowing people to accept their condition and honestly question their fate, no matter how they handle the challenge, might be enormously helpful for some. They don’t need to fear honest discussions.
“No, you don’t have to be upbeat all the time.”
“Yes, you can talk about your sense of loss.”
“You can’t cause any harm by facing the difficult topics.”
Patients do not risk disaster if they react appropriately to stress.
Cancer Centers like ours provide resources for patients and families who are dealing with stress, and I commonly suggest people explore the resources in our Quality of Life Center. The goal is not to regain a positive attitude, though. It might be to improve a relationship or understand and manage their lives at a stressful time. The small victories come, not always with cure, but at the moments of healing.
The following is feedback received for this blog:
Please edit to add the "s" to "he' when referring to the wonderful woman author, Jimmie Holland.
- Liz McMillan
Sorry for the oversight. My apologies.
- Bruce
Having personally survived head & neck cancer (base of tongue squamous, stage 4 with bilateral metastasis of lymph nodes) 17 years ago, thanks to the recommended treatment from Sloan-Kettering of co-combatant chemo and radiation, I have a few thoughts on a positive attitude. To me, it's what helped me stay focused on beating the cancer. It made me feel like I had a chance, which in turn reduced the stress of negative possibilities and the debilitating treatments. A positive attitude gives you the needed push to keep trying anything and everything to beat the disease and keeps you from sitting around going "woe is me", or "why me"! I looked at it as if it were a journey. Another diversion on the path of life. I didn't have a choice of going down the path (never a smoker or heavy drinker) so I took it as any other diversion, stay positive, focus on what can be done, let your care givers do their best, and pray--a lot! I've always said that the medical community tried their best to kill me (after my second week of 5FU, I understood what the FU stood for), and prayers and a positive attitude saved me.17 years later, I still believe this! I've been blessed to work as a Professor for the past 15 years, retired from the Air Force Reserves after 35 years and still exercise and play racquetball 3 days a week, thanks to the "new" treatment recommended by Sloan-Kettering in 1996.
- Al Smith
