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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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IT REMAINS REASONABLE FOR CANCER PATIENTS TO PARTICIPATE IN THE FIGHT FOR RECOVERY

The most significant conclusion to be drawn from an article published
in the British Medical Journal of November 9, 2002, (Petticrew
article)(1), is a reiteration of what scientists interested in the study
of the mind/body relationship have known for at least 25 years: it is
biologically plausible that the psychosocial efforts of a cancer patient
may extend survival. However, the tone of the article and the comments of
one of its co-authors, stating definitively that the efforts of the
patient can have no such effect, have been a source of unnecessary
discouragement to a great many people with cancer. “Experts” have a duty
to continue to tell those with cancer that their psychosocial efforts may
have a positive effect on the course of the disease, without the
possibility of blame if their efforts do not turn out as hoped. “Experts”
should not discourage cancer patients from participating in the fight for
recovery unless there is clear evidence that there is no cause and effect
relationship between their efforts and outcome. The evidence at this time
is that such relationship is biologically plausible.

What the Petticrew article asked, in practical terms, is the
following question: do the psychological efforts of a cancer patient
affect the outcome of cancer? The actual title is Influence of
psychological coping on survival and recurrence in people with cancer:
systematic review. The authors conducted a “systematic review of [26]
published and unpublished prospective, observational studies” to summarize
the effect of psychological coping styles on survival and recurrence in
patients with cancer. The article considered the affect on the illness of
fighting spirit, hopelessness/helplessness, denial or avoidance, stoic
acceptance, and fatalism. The authors’ conclusions are as follows:

“Conclusion: Although the relation is biologically plausible, there
is at present little scientific basis for the popular lay and clinical
belief that psychological coping styles have an important influence on
overall or event-free survival in patients with cancer.

“Our findings show that such [psychosocial] interventions may be
inappropriate, at least when they are used with the aim of increasing
survival or reducing risk of recurrence.”

Mark Petticrew, co-author of the study is quoted in the Los Angeles
Times Health Section, 11/18/2002 as saying:

“The [Petticrew] study adds to what we know by showing that coping
styles don’t affect cancer out come” (emphasis added.)

This is difficult to understand because they support their conclusion
that “coping styles [psychosocial efforts] don’t [can’t] affect the out
come of cancer” and “may be inappropriate,” by a specifically contrary
phrase indicating it is biologically plausible that coping styles may
affect the outcome of cancer. They state in their conclusion, using their
words in slightly different structure “Although the relation[ship] is
biologically plausible, that psychological coping styles have an important
influence on overall or event free survival in patients with cancer, there
is at present little scientific evidence [of that fact.]”

This is, of course, the state of our knowledge and, in addition to
acknowledging that patients who choose to fight for recovery in groups
report improved quality of life (no small benefit), what all reputable
scientists have been saying for many years. Further, the authors of the
studies that show such a relationship have consistently refrained from
interpreting their results as definitive. Only charlatans promise
recovery from psychosocial efforts. That this is the state of our
knowledge is reinforced by Donald Rosenstein, M.D., chief of the
psychiatry consultation service at the National Institutes of Health
Clinical Center. In an NCI Internet posting dated 01/23/2002 concerning
the efficacy of cancer support groups, a psychosocial intervention, Dr.
Rosenstein makes the following statement:

“Whether support group participation may extend survival is an open
question. There is a lot we still don’t know about the effects a cancer
patient’s mindset may have on their disease. . . .There is some data to
suggest that some individuals’ lives may be prolonged. There may be
variables associated with longer survival that we have not yet
identified.”

As is said in the Patient Active Concept, which is the basis for The
Wellness Community:

“Cancer patients who participate in their fight for recovery along
with their physicians will improve the quality of their lives and may
enhance the possibility of recovery” (2).

Finally, to inform the public that “the popular lay and clinical
belief [is] that psychological coping styles have an important influence
on overall or event-free survival in patient with cancer,” is just wrong,
and phrases such as “ . . .there is often pressure on patients with cancer
to engage in ‘positive thinking,’” without some type of evidence that such
pressure is exerted and by whom, is not only broadly inaccurate but
counter productive. I find it even more difficult to understand coming
from those whose stated purpose is to be helpful to those with cancer.

ENDNOTES

(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 (9 November). http://bmj.com.

(2) Those interested in knowing more about the Patient Active
Concept or The Wellness Community should consult
www.thewellnesscommunity.com.

Competing interests:  
None declared

Competing interests: No competing interests

16 December 2002
Harold H. Benjamin
Founder
The Wellness Community