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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:

A response to the systematic review

A response to the systematic review - ‘Influence of psychological
coping on survival and recurrence in people with cancer: systematic
review”. Petticrew M et al. BMJ. 2002;325:1066-1085

The Bristol Cancer Help Centre agrees with the authors that people
with cancer should not feel pressurised into adopting a particular coping
style. This is unlikely to be helpful at a time when they are already
under a great deal of pressure. However we do believe that psychological
interventions have an important part to play in not only improving the
quality of life for people with cancer, but also quite possibly prolonging
survival. Leslie Walker in his recent review (1) states that not only is
there substantial evidence that psychological interventions are helpful in
alleviating stress, but also that there is a growing body of evidence to
suggest they may influence survival.

Although many of the studies reported in the review were reported as
methodologically sound, several used psychological self-report inventories
that have since been widely criticised. It is now recognised by
researchers such as Temoshok (2) that the most effective way of looking at
emotional responses to the diagnosis of cancer is by clinical profiling.
Cunningham (3,4) also suggests that rather than self-report inventories we
need to use qualitative methods that allow a much more in depth analysis
of the patients. His work that combines qualitative analysis with a
quantitative rating, is carried out with people who have metastatic cancer
undergoing a psychological programme intervention. His studies
demonstrate a significant relationship between the degree that people are
involved with the psychological work and survival. His hypothesis is
that enhanced survival depends not only on psychological attributes, but
also on the application of the techniques used in therapy. This is with
the understanding that if the mind is to affect the regulation of cancer
progression via endocrine or immune intermediary mechanisms, there needs
to be a change in mental status. This may then result in the change of
some of these physiological regulators. The study by Watson and
colleagues (5), in which a positive score on a depression score six weeks
after the diagnosis of primary breast cancer significantly reduced
survival, points to the importance of psychological states to outcome.
The work of Sephton and colleagues (6) shows that those women with
cortisol disregulation at the time of the recurrence of breast cancer had
a significantly reduced survival time. These studies suggest that
psychological state affects the biology of tumour progression. Without
such influences the disease is likely to continue to progress at the same
time.

Rather than looking back, surely now is the time to look ahead at
developing further creative research designs such as Cunningham’s that can
intelligently capture the benefits of effective coping styles, and any
psychological intervention that may enable these to be bought about. We
also believe that it will become possible to measure the internal
physiological states suggesting disregulation of mind body biorhythms
using such measures as Capnography and heart rate variability that reflect
the flexibility or otherwise of the internal physiology. Maybe then in
another ten years we will be seeing a very different picture emerging from
the data.

Helen Cooke - Director of Therapy, Dr David Beales - Member of the Therapy
Advisory Board

Bristol Cancer Help Centre

1. Lewis et al. (2002) The Psychoimmunology of Cancer. 2nd Edition.
Oxford University Press (P 252)

2. Watson M et al. (1999) Influence of psychological response on survival
in breast cancer: a population-based cohort study. Lancet. 354. 13331-1336

3. Temoshok L R . Letter page. Lancet. Jan 2000. Vol (355)

4. Cunningham et al. (2002) ‘Fighting for life: A qualitative analysis of
the process of psychotherapy-assisted self-help in patients with
metastatic cancer. Integrative Cancer Therapies.1(2):146-161

5. Cunningham et al. (2000) ‘A prospective longitudinal study of the
relationship of psychological work to duration of survival in patients
with metastatic breast cancer’. Psycho-oncology, 9: 323-339

Competing interests:  None declared

26 November 2002
Helen J Cooke
Director of Therapy
Cprnwallis Grove, Bristol, BS8 4PG
Bristol Cancer Help Centre