I'm not a joiner. I don't do support groups. Throughout my breast cancer treatment, my primary care provider and my psychiatrist constantly urged me to get into a support group. "It improves your chances of survival," they told me. I read books that said the same thing. It came to seem almost like a judgment, that if I was unwilling to do the required sitting and sharing, I was inviting death to make a house call. My doctors disapproved of my decision and they disapproved of me. It made me angry and it caused me to question my own intuitive understanding of what I needed to do to get through treatment.I didn't care what anyone said. The thought of sitting around with a group of women, some of whom definitely would not survive the fight, and talking about having breast cancer made me just want to go ahead and die. I decided that, if that's what was required of me, I'd have to take my chances. No support groups.
If you asked the people who saw me every day, they would tell you that I always maintained a positive attitude throughout my treatment. They're right, but they're also wrong. Mostly I was focused on how much everything hurt. I was primarily aware of how big the pain was. It was as if I'd become a 600 pound lump of agony. I was open to distraction, though. As a matter of fact, I sought out distraction wherever I could find it and whenever I had the energy to use it. When people told jokes, I laughed. When they looked at me and started crying, I comforted them. Then I made a joke, so they could be distracted from my pain. I don't think they knew the diversion was less for them than for me.
I was not upbeat all of the time, not even most of the time. I'm not even sure what "maintaining a positive attitude" really means in that context. I was relatively confident that I wasn't getting ready to die any time soon. I was certain that I was going to be required to endure whatever the treatment regimen dictated. Is that the same as being upbeat? I'm not so sure.
Today, I read an article from WebMD that made me feel better about being asocial and stoic. It turns out that the commandments "Thou shalt be positive or die" and "Thou shalt participate in support groups or die" are wrong. Here's the proof:
Attitude Doesn't Affect Cancer Survival
Oct. 22, 2007 -- Having a positive attitude may help cancer patients deal with their disease, but it doesn't directly affect survival, according to one of the largest and most rigorously designed investigations ever to examine the issue.
The study included more than 1,000 people treated for head and neck cancer; the emotional state of patients was found to have no influence on survival.
The findings add to the growing evidence showing no scientific basis for the popular notion that an upbeat attitude is critical for "beating" cancer, says University of Pennsylvania School of Medicine behavioral scientist James C. Coyne, PhD, who led the study team.
"I wish it were true that cancer survival was influenced by the patient's emotional state," he tells WebMD. "But given that it is not, I think we should stop blaming the patient."
'The Tyranny of Positive Thinking'
Jimmie Holland, MD, agrees. The Memorial Sloan-Kettering Cancer Center psychiatrist is a longtime critic of the "mind over cancer" proponents who tell patients they must stay positive to survive their disease.
In her book The Human Side of Cancer, Living with Hope, Coping with Uncertainty, Holland coined the term "the tyranny of positive thinking" to describe the belief.
"The idea that we can control illness and death with our minds appeals to our deepest yearnings, but it just isn't so," she tells WebMD. "It is so sad that cancer patients are made to believe that if they aren't doing well it is somehow their own fault because they aren't positive enough."
Holland does acknowledge the benefits of staying positive during cancer treatment, and she is an advocate of techniques like relaxation, meditation, support groups, and prayer to help patients cope with their disease.
But she says there is no credible evidence that positive thinking alone directly influences tumor growth.
"People really want to believe this, so even very good studies like this one probably won't change public thinking," she says. "But the scientific community is getting the message."
Attitude and Cancer Survival
The newly published study included 1,093 patients with head and neck cancer who completed quality-of-life questionnaires during their treatment.
Coyne says the study group was limited to patients with a single cancer who had similar treatments to better assess the impact of state of mind on survival.
A total of 646 patients died during the study follow-up. Even after accounting for other variables that could affect survival, a patient's emotional state was found to have no bearing on whether or not he or she lived or died.
The study appears in the Dec. 1 issue of the American Cancer Society (ACS) journal Cancer.
In a separate review of other studies published earlier this year, Coyne, University of Pennsylvania colleague Steven Palmer, PhD, and ACS researcher Michael Stefanek, PhD, found insufficient evidence that participation in psychotherapy or cancer support groups plays a role in survival.
In that report, the researchers concluded that the hope that emotional state is a driving factor in cancer outcomes "appears to have been misplaced."
"If cancer patients want psychotherapy or to be in a support group, they should be given the opportunity to do so," they wrote in the journal Psychological Bulletin. "There can be lots of emotional and social benefits. But [patients] should not seek such experiences solely on the expectation that they are extending their lives."
