Making patient relevant clinical research a realityBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6627 (Published 23 December 2016) Cite this as: BMJ 2016;355:i6627
All rapid responses
Many thanks indeed for your article. It's about time that researchers consulted patients about topics for research instead of just asking them to look over the lay summary of a Cochrane systematic review. One topic that I should be delighted if someone would consider is the possible connection between depression and cancer. Be warned: no profit will be made by a drug company in the conducting of this research.
With the use of Big Data it seems to me that it would be fairly simple, without compromising confidentiality, to link up prescriptions for antidepressants with subsequent diagnoses of cancer. I am particularly interested in the possible connection in the case of breast cancer, since this illustrates my own story, but there may well be a connection with other cancers as well.
This is not a new idea. Galen, in the second century A.D., observed that 'melancholy' women developed breast cancer. Lawrence LeShan, working as a psychotherapist with cancer patients in the USA, found that 'In almost all cases, damage had been done to the child's developing ability to relate early in life, usually during the first seven years'. (1) Subsequent stresses followed in adult life. My own experience running a cancer support group for 13 years also found that many patients themselves thought that their problems started with traumatic events, for instance, marriage break-up, redundancy, or long-term care for a disabled child or an elderly relative with dementia, leading to chronic stress. Some also spoke of childhood sexual abuse. Cancer had actually given them the excuse to seek counselling for the first time in their lives.
It seems to me that some cancers might well be prevented if talking therapy were offered to people in crisis rather than antidepressants or anxiolytics. It might even be possible that such drugs could be carcinogenic: but this is not likely to be mentioned in the British National Formulary. The harms of antidepressants are only now beginning to be fully appreciated, with the work of Peter Gøtzsche and others. (2) In the long term, if talking therapy were offered rather than drugs this could save the NHS money. But large-scale research needs to be done to provide clear evidence that this would indeed be helpful. Here, then, is my suggestion for someone to take up.
1. Lawrence LeShan: You can fight for your life: emotional factors in the causation of cancer (Evans, New York, 1977, p.50)
2. Andreas Ø Bielefeld, Pia B Danbury and Peter C. Gøtzsche: Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers. Journal of the Royal Society of Medicine 2016 Vol 109 (10) 381-392.
Competing interests: I have worked as a counsellor, but I am now retired.