Does the emotional state of a cancer patient have an impact on the progress of a cancer? This very sensitive question understandably never fails to generate controversy.
Recent media reports might lead many to conclude that the question has now been answered with a study claiming that there is no connection between attitude and cancer. However, looking deeper into the study these reports are based on shows that the jury is likely still very much out on the question.
Recently, a study from the University of Pennsylvania (still yet to be published) was reported as concluding that the emotional attitude of a patient had no impact on survivor rate. This conclusion was widely and prominently carried in the North American media. The front page lead headline in my Montreal newspaper was typical "Attitude Can't Beat Cancer" (Montreal Gazette, October 22, 2007).
The apparent strength of the study was in the number of the patients. The study, expected to be published in the Dec. 1 issue of Cancer, apparently drew data from almost 1,100 patients enrolled in two phase III clinical trials for new head and neck cancer treatments. The patients completed questionnaires about their attitude and social networks at the beginning of the study and at follow-up. The questionnaire included five questions to assess emotional well-being, including such items as "I am sad" and "I am losing hope in my fight against my illness." By the end of the five-year study, 646 patients died. When the data was analyzed, the researchers found that emotional status had no effect on the course of the cancer or the patient's survival.
In the rush for attention grabbing headlines and to get out a story, relevant and important criticism of the study was missed by many of those in the media. The conclusion as reported sounds plausible and authoritative. However, such reporting may be doing a great disservice to cancer patients and their families. One could easily assume from reading these reports that the case of the impact of attitude and cancer was now closed.
What many of the reports failed to include was that this study is already drawing criticism from other experts. In digging a little deeper, examples of published reports of this criticism can be found.
For example, Dr. David Spiegel (associate chairman of psychiatry and behavioral sciences at Stanford University School of Medicine in California) is reported (U.S. Health News, 22/10/07) as observing, "The authors (Coyne et al) vastly overstate the quality of their data and the findings. They used a subscale of a quality-of-life measure which is hardly a reliable measure of depression and provides, by definition, limited variance in mood, making it, by design, difficult to show a relationship with any other variable."
Dr. Spiegel noted further "But positivity or negativity are not the issue. What matters is the way in which a cancer patient approaches the stresses in his or her life."
Just these two aspects indicate to me that the study's conclusion is far from the definitive last word on the subject that it is portrayed to be. If an expert of the caliber of Dr, Spiegel challenges both the methodology and the relevance of the questions that the study asks, the least I can conclude is that the jury is still very much out on this important question.
The truly sad thing about all this is that people's attitudes may be unnecessarily negatively influenced by reading such reports with who knows what damaging implications for their health. We need to demand higher standards from our press when they are dealing with such important questions. This is no area for simplistic thinking. What it does emphasize again to me is the need for much more thorough research in this area.