November 5, 2007

Attitude Change: A Positive Outlook Does Not Beat Cancer?

Many believe that a positive attitude will increase one’s lifespan, specifically for someone who encounters an illness or disease such as cancer. However, a new study claims that this belief is ill-conceived. Researchers from the University of Pennsylvania analyzed the emotional states of about 1,100 patients diagnosed with head and neck cancer, as pictured on the left. Conclusions show that survival was not associated with patients’ emotions. Other factors, such as gender, disease stage, and tumor site were also taken into consideration. Even then, the link between positive emotions and cancer survival rates could not be made. Such news is unfortunate and disheartening, and, as stated by Dr. James C. Coyne from the University of Pennsylvania, “The hope that we can fight cancer by influencing emotional states appears to have been misplaced.”

This finding has inspired me to explore the blogosphere this week. I decided to comment on two very compelling posts after reading various weblogs. My comments can be found by following the links. However, for the purpose of convenience, they can be found below. The first post that I chose to comment on is from the blog The Cheerful Oncologist by Craig Hildreth, M.D., a medical oncologist. Rated as one of the world’s top bloggers on health and medicine, he discusses the study regarding emotions and cancer survival in his post “Put On a Happy Face - That’s an Order?” The second post that I comment on is published by Steven Novella, M.D., an academic clinical neurologist at Yale University School of Medicine. His post, “Mood, Cancer, and the Placebo Effect,” argues that “positive outlook does not help our bodies fight cancer” due to lack of scientific evidence to support this conclusion.

“Put On a Happy Face - That’s an Order?”

First, I would like to say that I found your post and links quite informative. It is interesting that cancer patients who have a positive outlook on life are no more likely to survive than patients who are depressed. I would have thought otherwise. The studies could not find significant evidence to link positive attitude to a better outcome in cancer survival. As you have in your post, I would also ask, “Are they telling us that all this ‘keep your head up’ advice given to cancer patients is worthless?” I believe that staying positive will benefit a cancer patient mentally and physically. In general, maintaining a good attitude helps everyone. I would like to point out that the information presented in the study conducted by James C. Coyne, Ph.D. and colleagues is exclusively representative of patients with head and neck cancer. Therefore, patients diagnosed with other cancers, such as breast and prostate cancer, may benefit from having a positive attitude. As stated in the referenced article “Emotions Don’t Play a Role in Cancer Survival,” the role of endocrine factors associated with breast and prostate cancer may yield varying results. Do you believe that the outcome would differ for patients with breast and prostate cancer in comparison to those with head and neck cancer? As a future physician, I would also “strongly support the sowing of hope and joy in the lives of my patients.” Since multiple studies “[do not] suggest that they will live a longer life with such an attitude,” patients have to know that they will just live a “better one” as you concluded. Are there any studies which oppose the notion that positive emotions do not play a role in cancer survival outcomes?

“Mood, Cancer, and the Placebo Effect”

Your post offers a valid explanation for the reason why positive moods do not necessarily lead to better health outcomes and survival rates. The belief that emotions play a key role in cancer survival is one that many, including myself, share (see image to the right). After reading “Mood, Cancer, and the Placebo Effect,” I understand that one can not generalize or assume outcomes without scientific evidence. Speaking with a couple of cancer survivors, however, it became clear that they attribute their favorable prognosis to a positive outlook, among other factors. I then would ask why they make this connection so passionately. This question can be partly answered with your statement “Just being distracted [with good moods] will decrease a person’s perception of their pain.” The claim that you make regarding “rigorous effective clinical thinking” is an important point in your post. Humans tend to “oversimplify” and it is not “a legitimate or effective intellectual strategy.” Overall, I commend you on a well written post regarding the topic of emotions and health outcomes. You presented points that explain the misleading notion of treatment generalizations that “lie outside the bounds of scientific medicine.” I noticed that alternative medicine is incorporated in your discussion and I wanted to know if that included herbal remedies. Lastly, it is important that people understand that positive moods do help with other health problems like heart disease as you stated. The clarification of this statement is necessary since “we don’t want to hastily generalize in the other direction.” Do you think there will be future studies which will refute the arguments made in the aforementioned study?
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