For several years, I treated a man with a recurring sarcoma of the neck and pharynx. He gradually developed an intense rage against his malignancy and the cancer battle evolved into a personal mission. He read voraciously, he spent hours on the phone and Internet, and he pursued every available experimental treatment. Whenever he received a recommendation, he trekked around the country until he was satisfied with the course he had chosen.
His attitude was strong, positive, and consistently hopeful. Despite this, he eventually lost his struggle. His well-attended visitation was a testimony to his remarkable life and personal resolve against cancer.
His intensity prompted me to ask: How did his attitude and effort affect his survival? If a patient tries “hard enough,” can cancer be controlled?
A recent article would argue that a positive attitude does not prolong life but does improve Quality of Life. In a Canadian study, women with metastatic breast cancer randomized to receive group psychosocial support did not survive any longer than women who were not in a support group, although they had an improved mood and some had less perceived pain. (Goodwin, NEJM 2001 345:1719-1726)
That’s discouraging, right? It depends on your interpretation. From my vantage point, the message that there is no correlation between attitude and survival is a gift for our patients and for us.
“No, you don’t have to be upbeat all the time.”
“Yes, it is safe to be honest about your fear and sense of loss.”
“You can’t cause any harm by talking to your dad about difficult topics.”
It can free patients and families if they recognize that they are not risking disaster by reacting appropriately to stress. Theologians might refer to this as “Grace.”
I call it a place to begin a discussion.
