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?”

Comment:

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”

Comment:

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?

Prostate Cancer: Survival Rates Vary According To Season

A current study on prostate cancer conducted by a team of American and Norwegian researchers revealed that the season of prostate cancer diagnosis is linked to the survival rate. Researchers analyzed the data of 46,205 Norwegian men who were diagnosed with prostate cancer from 1964 to 1992. They were divided into four different groups according to the seasons (image to the right). The overall findings suggested that men who were identified with having prostate cancer in the summer and fall have better survival than those who were diagnosed in the winter and spring. More specifically, those diagnosed in the winter and spring are 20 percent more likely to die within three years then those who are diagnosed in the summer and fall.

Each of the four seasons vary in their daily temperatures and weather patterns. The summer and autumn months, defined from June to November, have higher levels of calcidiol, an intermediate metabolite of vitamin D (see chemical structure to the bottom left), through ultraviolet exposure—a vitamin whose exposure is not as prevalent during the winter and spring seasons. The study, published in the journal, The Prostate, did not prove that vitamin D is the determining factor. However, study co-author Dr. Tomasz Beer, director of the prostate cancer program at the Oregon Health & Science University Cancer Institute, suggested that further research should be conducted on this possibility. Vitamin D has been shown to regulate cell differentiation and help sustain the immune system. Most importantly, this fat soluble vitamin is also known to slow down cancer growth. Alternate factors associated with vitamin D included age, food intake high in vitamin D, vacations in sunny southern areas, and the location of residency in Norway, were also examined to determine whether survivability was affected. Of all the variables examined, age is the risk factor that influences the chances of being diagnosed with prostate cancer because younger males readily produce more vitamin D than older males. As mentioned by the researchers “the capacity of skin to produce vitamin D when exposed to sunshine is about 40 percent lower in men 75 and older than in men 60 and younger” and therefore younger men had a slightly better rate of survival.

In this study, a relationship between the varying seasons and survival rates of prostate cancer has been proven to exist. Despite these findings, additional factors that could potentially affect the study include the type of treatments administered and the stage of the disease at the time of diagnosis. The older patients normally have a more advanced diagnosis of prostate cancer and are subjected to different treatments. This may have an overall effect on the survival rate. Furthermore, the skin color of these patients is another risk factor to consider in such a study. Dark-skinned people require more sun exposure to make vitamin D. This is due to the thickness of the skin layer called the stratum corneum, which alters the amount of absorbed ultraviolet radiation.

There are several factors to consider when conducting a study such as the one discussed in this post. The physical attributes, life style, environmental surroundings, and genetics are a few that need to be measured for a thorough research study. The discovery that certain seasons contribute to a better outcome in survival rates among men with prostate cancer seems promising for future treatments. However, since the study was conducted with Norwegian men, not all factors may be applicable to the general population of those who are diagnosed with prostate cancer. The importance of integrating vitamin D in our life style, especially prostate cancer patients, can help reduce the development of cancer. Researchers as early as 1936 were aware that skin cancer patients have reduced rates of other cancers when exposed to UV light even though excessive sun exposure may give rise to skin cancer. Prostate cancer patients and the general population need to be advised that moderation is the key in the intake of vitamin D and ultraviolet exposure as it is for other healthy lifestyle habits.