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Influence of psychological coping on survival and recurrence in people with cancer: systematic review

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7372.1066 (Published 09 November 2002) Cite this as: BMJ 2002;325:1066

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Coping with cancer should be a matter of “living in the meanwhile”

EDITOR - Dear sir, we read the paper of Petticrew and collegues (1)
showing that there is no consistent association between psychological
coping and survival from or recurrence of cancer. We found it a very
interesting systematic review on the issue. Here we focus on the following
statement: «Overall we found little evidence that coping styles play an
important part in survival from cancer. This is an important finding
because there is often pressure on patients with cancer to engage in
"positive thinking," and this may add to their psychological burden (2-3).
It has been suggested that clinicians need to detect coping styles such as
helplessness or hopelessness and treat them vigorously (4). Our findings
show that such interventions may be inappropriate, at least when they are
used with the aim of increasing survival or reducing the risk of
recurrence» (1).
We found it very useful from a patient’s perspective. In fact, the common
belief on an imaginary role of the “positive thinking” on cancer
outcomes could be finally defeated thus allowing to all the cancer
patients that have the great sin not being “positive” the right to be
discouraged or depressed from their situation. Furthermore, this paper
might indirectly contribute to take off the terrific “ghost” raised by the
supporters of complementary medicine about patient’s responsibility
towards his/her disease; for example, «Cancer is expression of our time
and our conceptions of the world. We experience in the form of cancer just
what we ourselves live. People have the cancer because people themselves
are cancer» (5).
By the way, what we are attempting to state here is that the cancer
patients have to fight not only against their disease but also against the
“common hypocrisy” to project on the suffering people the whole
incapability of our western society to face their needs. The article of
Petticrew and collegues1 is certainly useful to hand out with these
problems.
Nevertheless, we think it should be essential to consider that the
appropriateness of such interventions might take into account another
important outcome, i.e. the improvement of patient’s “living in the
meanwhile”. In other words, we think that the authors failed to include a
major outcome related to cancer survival, i.e. the quality of “life while
being ill” that could also have a different value from patient’s
perspective, perhaps even greater than a longer life.

Ciardullo Anna Vittoria, MD, MSc
Daghio Maria Monica, MA
“Lab for Citizen Empowerment” - Azienda USL, Modena, Italy
Salvatore Panico, MD MSc
Department of Clinical and Experimental Medicine, “Federico II”
University, Naples, Italy

References:
1 Petticrew M, Bell R, Hunter D. Influence of psychological coping on
survival and recurrence in people with cancer: systematic review. BMJ 2002
; 325:1066-75
2 Wilkinson S, Kitzinger C. Thinking differently about thinking positive:
a discursive approach to cancer patients' talk. Soc Sci Med 2000; 50: 797-
811
3 De Raeve L. Positive thinking and moral oppression in cancer care. Eur J
Cancer Care 1997; 6: 249-256
4 Watson M, Haviland J, Greer S, Davidson J, Bliss J. Influence of
psychological response on survival in breast cancer: a population-based
cohort study. Lancet 1999; 354: 1331-1336
5 Gazzola F. Il ruolo degli shock emozionali nella genesi dei tumori.
Naturalis Medicina.it

http://www.naturalismedicina.com/articolo.asp?i=153, site visited in
2002, 6th December

Competing interests:  
None declared

Competing interests: No competing interests

07 December 2002
Anna V Ciardullo
MD MSc
Monica Daghio, Salvatore Panico
“Lab for Citizen Empowerment” – Azienda USL - Viale Muratori, 201 - 41100 - Modena, Italy