Controversies in cancer and the mind: effects of
psychosocial support.
Sampson W. Semin Oncol. 2002 Dec;29(6):595-600. Stanford University School of
Medicine, Stanford, CA, USA.
In the last decades of the twentieth century, interest in effects of consciousness on
health and illness generated several lines of investigation into effects on cancer. Animal
studies showed sensitivity of some cancers to hormonal and stressful influences. However,
those findings did not translate into effects on humans, nor did they lead to advances in
understanding of human cancer. The proposal that emotional state or stress, mediated
through psycho-neuro-immunologic mechanisms would affect cancer generation or growth,
resulted in conflicting information. Major surveys found no relationship. The
proposal of a cancer personality (Type C) also was not confirmed. Initial observations
that depression and stress affected human cancer seem to have best been explained by
misinterpretations of cause and effect. By the mid 1990s, a remaining thesis--effect of
psychosocial support on longevity and the course of cancer--was yet to be resolved.
Initial positive results, especially findings in two popularly quoted studies, were not
confirmed; they seem to have been due to inadequate numbers (chance) or to artifacts in
study design or implementation. Psychosocial support may result in better adjustment
and quality of life, but it does not directly affect the evolution of human cancer.
Mind and cancer. do psychological factors cause cancer?
Dalton SO, Eur J Cancer. 2002 Jul;38(10):1313-23. Department of
Psychosocial Cancer Research, Institute of Cancer Epidemiology, The Danish Cancer Society,
Copenhagen, Denmark.
We have reviewed the evidence for an association between major life events, depression and
personality factors and the risk for cancer. We identified and included only those
prospective or retrospective studies in which the psychological variable was collected
independently of the outcome. The evidence failed to support the hypothesis that major
life events are a risk factor for cancer. The evidence was inconsistent for both
depression and personality factors. Chance, bias or confounding may explain this result,
as many of the studies had methodological weaknesses. The generally weak associations
found, the inconsistency of the results, the unresolved underlying biological mechanism
and equivocal findings of dose-response relationships prevent a conclusion that
psychological factors are established risk factors. However, certain intriguing findings
warrant further studies, which must, however, be well conducted and large and include
detailed information on confounders.
Psychoneuroimmunology and
cancer: fact or fiction?
Kiecolt-Glaser JK, Eur J Cancer. 1999 Oct;35(11):1603-7. Department of Psychiatry,
Ohio State University College of Medicine
There is substantial evidence from both healthy populations as well as individuals with
cancer linking psychological stress with immune downregulation. This discussion highlights
natural killer (NK) cells, because of the role that they may play in malignant disease. In
addition, distress or depression is also associated with two important processes for
carcinogenesis: poorer repair of damaged DNA, and alterations in apoptosis. Conversely,
the possibility that psychological interventions may enhance immune function and survival
among cancer patients clearly merits further exploration, as does the evidence suggesting
that social support may be a key psychological mediator. These studies and others suggest
that psychological or behavioural factors may influence the incidence or progression of
cancer through psychosocial influences on immune function and other physiological
pathways.
Psychosocial correlates of cancer relapse and survival: a literature
review.
De Boer MF, Patient Educ Couns. 1999 Jul;37(3):215-30. Department of Head and Neck
Surgery, University Hospital Rotterdam Daniel den Hoed Cancer Center, Rotterdam, The
Netherlands.
This article reviews literature on the psychosocial correlates of cancer relapse and
survival from 1979 through 1995. The factors studied were structured according to a
theoretical model of coping with cancer. Reviewed studies have shown that factors most
frequently evaluated were depression, anxiety, hopelessness/helplessness, hostility,
marital status and social involvement. Mainly inconsistent results were found. The
strongest evidence for a relationship between psychosocial variables and prognosis was
found for social involvement/social support; in 7 of 15 studies a positive relationship
was demonstrated, while no negative associations were found. Coping styles e.g.,
fighting spirit and stoic acceptance, and severe/stressful life events were found to have
no conclusive influence on the length of survival. Important determinants of the
coping model, such as uncertainty and information given by the specialist were not studied
as possible predictors of survival and/or relapse free period. Among the factors that
showed no correlation at all was multidimensional health locus of control. For the
inconsistent findings, a considerable number of methodologic shortcomings with respect to
study design, sample size, measure and statistical analysis are enumerated.
The studies below discuss the role of prayer.
Spirituality and care of prostate cancer patients: a pilot study.
Bowie J, Natl Med Assoc. 2003 Oct;95(10):951-4. Johns Hopkins
University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD
While one-third of the men reported their doctors had been in contact with their clergy,
two-thirds would like their doctor and clergy to be in contact with one another. This is a
pilot study that incorporated both qualitative and quantitative data collection but with
the small sample, has limited generalizability. However, this work does suggest that integrating
spirituality and religion into medical care may be beneficial to prostate cancer patients.
Physicians and physician organizations should engage in future research in this area.
The effects of spirituality on well-being of people with lung
cancer.
Meraviglia MG. Oncol Nurs Forum. 2004 Jan-Feb;31(1):89-94. School of
Nursing, University of Texas, Austin, TX
Higher meaning in life scores were associated with higher psychological well-being and
lower symptom distress scores. Higher prayer scores were associated with higher
psychological well-being scores. Aspects of spirituality, meaning in life, and prayer
have positive effects on psychological and physical responses in this group of people with
lung cancer.
Meaning of illness and spirituality in ovarian cancer survivors.
Ferrell BR, Oncol Nurs Forum. 2003 Mar-Apr;30(2):249-57. Department of
Nursing Research and Education, City of Hope National Medical Center, Duarte, CA
Spirituality was relied on heavily as a coping mechanism, as well as a method of deriving
meaning from the cancer experience. The nature of ovarian cancer implicates specific
characteristics that alter the meaning of Quality of Life (QOL) and survivorship. Spirituality
is an important component of QOL and contributes to the process of deriving meaning from
the ovarian cancer experience.
Spirituality and quality of life in gynecologic oncology patients.
Gioiella ME, Cancer Pract. 1998 Nov-Dec;6(6):333-8. Massachusetts General
Hospital, Department of Social Service, Boston, USA.
Patients with gynecologic cancers other than ovarian reported a better quality of life
(QOL) and a higher degree of spiritual, existential, and religious well-being. Older
patients consistently reported higher degrees of spiritual well-being and QOL than did
younger patients. Married patients consistently reported higher degrees of spiritual
well-being than patients who were not married (never married or separated). Catholic
patients scored higher in degrees of religious and spiritual well-being as well as in FLIC
scores than other patients. Despite the medical establishment's bias to the contrary,
religion and spirituality are positively associated with both physical and mental health
and may be particularly significant to terminally ill patients. |
