Attitude Doesn't Affect Cancer Survival

Optimism Doesn't Extend Life, but Can Improve Its Quality After Diagnosis

From the WebMD Archives

Feb. 9, 2004 -- Despite the popular belief that being optimistic may improve cancer survival, new research finds that attitude plays no role in survival outcome -- at least when it comes to advanced lung cancer.

Australian researchers report patients with a positive attitude fared no better than their less-upbeat peers, leading them to suggest that doctors who encourage cancer patients to remain hopeful following a diagnosis may be doing more harm than good.

Despite the somber findings, published online today and in the March 15 issue of Cancer, at least two experts hailed the study as an important one.

Somber Findings, Positive Result?

"This is a very important study because there is an expectation on cancer patients that they need to be positive or their tumor will grow faster -- and that's just nuts," says psychiatrist Jimmie Holland, MD, of Memorial Sloan-Kettering Cancer Center and author of The Human Side of Cancer, a book dispelling what she calls "the tyranny of positive thinking."

"The idea that if you're not an optimist, you're not going to do as well with this disease is just wrong, and it's a terrible thing to lay on people," Holland tells WebMD. "What this confirms is that if you're not optimistic by nature, it won't affect your cancer."

Herman Eyre, MD, chief medical officer for the American Cancer Society, also praised the study. Although optimism has been promoted by some as a path to longer survival for cancer patients, in reality the scientific evidence of its true role has been mixed.

"There are studies that find that a good attitude is a positive," he tells WebMD. "But sometimes, it gets to the point where patients are overpromised the role of a positive attitude, and wind up with an unrealistic expectation about their outcome."

A positive attitude can motivate cancer patients to take better care of themselves following a diagnosis. "Those who are optimistic are probably more likely to eat well, exercise regularly, stop smoking, and practice other behaviors that are helpful," Eyre says.

"But very clearly, attitude cannot overcome the importance of the basic underlying disease. And in this study, these people had a cancer where the median survival is 16-18 months. Attitude will not change that."

Positive Attitude: 'An Additional Burden'

For their study, researchers at six Australian cancer centers tracked 179 patients with a type of lung cancer that typically kills 85% of patients within five years. The patients were surveyed about their attitude and levels of optimism before treatment began, then six weeks after completing treatment. During the five-year study, all but eight patients had died.

The only trend noticed was a small but measurable drop in optimism as patients experienced the toxic effects of their treatment.

"Encouraging patients to be positive may represent just an additional burden," write the researchers. "We should question whether it is valuable to encourage optimism if it results in the patient concealing his or her distress in the misguided belief that this will afford survival benefits."

Still, at least one expert tells WebMD that cancer patients should try to stay upbeat.

"Being optimistic may not have any impact on the length of life, but it certainly has an impact on the quality of life," says Ann Webster, PhD, director of the cancer program at the Mind/Body Medical Institute run by Beth Israel Deaconess Hospital and Harvard Medical School.

"If you are optimistic and hopeful and have that fighting spirit, you will go through the whole cancer experience in a much better way than if you are depressed and hopeless. I don't think anyone has ever promised that attitude will cure cancer. What we say is that it may enable you to cope better and to feel better."

SOURCES: Schofield, P, Cancer, published online Feb. 9, 2004; in print March 15, 2004. Petticrew, M, British Medical Journal, Nov. 7, 2002; vol 325; pp 1066-1069. Jimmie Holland, MD, Wayne Chapman chair of psychiatric oncology, Memorial Sloan-Kettering Cancer Center, New York; cofounder, International Psycho-Oncology Society. Herman Eyre, MD, chief medical officer, the American Cancer Society, Atlanta. Ann Webster, PhD, health psychologist and director, cancer program, Mind/Body Medical Institute, Beth Israel Deaconess Hospital and Harvard Medical School, Boston.