Reviews

Coping with cancer

Petticrew and colleagues (p 1066) say that there is little evidence to show that mental attitude towards illness affects survival from or recurrence of cancer. It seems as though the fighting spirit doesn't increase your chances of survival, and a sense of hopelessness or denial doesn't worsen them.

The authors agree that their findings run counter to the popular belief that psychological coping styles are important. Search the web and it is clear that, evidence or no evidence, patients' groups see a positive attitude as all-important in coping with cancer.

From the home web page of the American Cancer Society (www.cancer.org/docroot/home/index.asp) you have access to a myriad of support groups, all extolling the need to be positive, and quizzes are available to score yourself on how you are coping. Although keeping your feelings inside is the top of the list of what not to do, the site offers balanced and reassuring comment on the complex emotions that may be felt over the course of the illness. The www.cancercare.org/ site offers education, support, and counselling, as does the Cancer Research UK website (www.crc.org.uk/).

Sites directed at doctors seem startlingly devoid of attention to psychological factors and possible coping strategies. Although Petticrew et al found 28 studies for inclusion in their systematic review, many sitesfor example, www.meds.com/colon/colon.htmlcontain little advice to doctors on what to advise patients. This site, like others, including the Institute of Cancer Research site (www.icr.ac.uk/index.html), provides excellent evidence based information on all forms of cancer, the complex aetiology, and treatment options, but its "coping with cancer" section reads very thin. It concentrates on coping with the side effects of treatment. In the section titled "emotional concerns," depression, anxiety, and post-traumatic stress disorder are listed as diagnoses not to miss.

The contrast in the amount of attention given to coping with illness is mirrored in how doctors and patients view and deal with illness. Survival from cancer is the medical endpoint that doctors focus on; perhaps we can now advise our patients that their coping style will not affect their chances of survival. Patient orientated websites will no doubt continue to encourage patients, foster their ability to cope better, and see survival as only part of the picture.

Alex Vass. 

BMJ avass{at}bmj.com