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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

Rapid Response:

Psychological coping styles, and cancer survival

The systematic review by Petticrew and co workers (1) fails to find a
link between psychological coping style and survival or recurrence in
cancer, extending their previously reported findings about the absence of
an association between stressful life events and the diagnosis of cancer
(2). The authors discuss a number of methodological inadequacies that may
have contributed to the earlier positive findings. Another possible factor
that may explain the lack of association between coping style, stress and
survival, in spite of the theoretically plausible mechanisms that might be
expected to show a link is that of the relative strength of effect of
biological, treatment-related and psychosocial factors. It is quite
possible that even if psychosocial factors have some influence on
survival, their power is negligible compared, for example, with the
biological characteristics, and tumour staging of both the patient and the
cancer.

The association between cancer outcomes and psychosocial antecedents
can be traced to second century medical texts, but the inclusion of
personality factors and coping styles into a risk equation that aims to
determine overall survival for people with cancer does not show any effect
(3). It is to be hoped that the work of Petticrew and co-workers will help
to dispose of the myth of the personal psychological contribution to the
outcome of cancer. Feelings of distress and guilt are not uncommon in
people with cancer, the socially defined meanings of the disease sometimes
acquiring a momentum of their own (4). The added expectation that the
person must fight, not become anxious or depressed, or show any hint of
avoidance or emotional suppression lest survival be put at risk, does not
make the process of living with the condition any easier and can have
devastating consequences, in particular if the illness recurs, suggesting
that the person has not tried hard enough (3).

There is a problem, however, between professionals and the public
when attempting to present and discuss the results of evidence-based work
of this kind, which seems contrary to strongly held popular views. In our
post-modern world it is easy for the personal views and experience of
individuals either to be given prominence against what is seen as dry,
biased, impersonal, in other words, scientific evidence, or else to be
dismissed by professionals as irrelevant. In the field of mental health
this conflict is evidently present (5) but the consumer-led approach to
health care currently prevalent extends the possible conflict to other
specialties. Although Greenhalgh has attempted to reconcile both the
narrative and biomedical approaches (6), it would seem that the challenge
for mental health is to integrate scientific evidence, with the individual
narrative.

Gary Orr

Specialist registrar

Jose Catalan

Consultant liaison psychiatrist

Psychological Medicine,
South Kensington & Chelsea Mental Health Centre,
1 Nightingale Place,
London SW10


DrGOrr@aol.com

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, 1066-1069

2. Petticrew M., Fraser J. M., Regan M. F.,
Adverse Life events and risk of breast cancer: A meta-analysis

3. Orr G (unpublished)
MSc Thesis – Imperial College of Science Medicine and Technology
The psychosocial aspects of breast cancer: A systematic review of the
literature
1999 (unpublished

4. Sontag S.,
Illness as Metaphor; AIDS and its Metaphors
Penguin Books; London: 1991

5. British Journal of Health Psychology: 1999, 4, 1-17Bracken P., &
Thomas P.,
Post-psychiatry: a new direction for mental health.
BMJ, 2001, 332, 724 – 727

6. Greenhalgh T.,
Narrative based medicine in an evidence based world.
In: Narrative Based Medicine
Eds. Greenhalgh T., & Hurwitz B.,
BMJ Publishing, London, 1998

Competing interests:  
None declared

Competing interests: No competing interests

29 November 2002
Gary M Orr
Specialist Registrar in Psychiatry
Jose Catalan
Chelsea and Westminster Hospital SW10