Put On a Happy Face - That's an Order?

Does keeping a positive mental outlook help cancer patients to live longer?

People who are depressed about their cancer are no more likely to die than people who keep a positive outlook, U.S. researchers reported on Monday.

The choice of medical reports that news services choose to disseminate continues to fascinate me, including this latest bit of research involving 1100 patients with locally advanced cancer of the head and neck area. I'm sure they picked this story because of the popular conception that those who keep a positive outlook when fighting cancer will have a better outcome. If one believes this then all the more thrilling for news editors when thousands of gasps are released over such headlines as "Positive Attitude Does Little to Boost Cancer Survival Odds, Study Says'.

Are they telling us that all this "keep your head up" advice given to cancer patients is worthless?

The researchers looked at pooled quality-of-life data for head and neck cancer patients receiving concurrent chemotherapy and radiation therapy and found the following:

Emotional well-being at baseline in the studies was measured with five questions on the FACT-G quality of life questionnaire evaluating whether patients felt sad, were losing hope, feeling nervous, worrying about dying, worrying that their condition would worsen, and whether they were proud of how they were dealing with their condition.

In univariate analysis, well-being was not associated with survival...Nor did well-being impact survival in multivariate analysis accounting for study protocol, demographics, smoking, cancer stage, and performance status...None of the exploratory subgroup analyses for study protocol, gender, primary tumor site, and cancer stage showed a significant effect of emotional state on survival. Addition of all the interactions to well-being did not improve association either.

The authors conclude that despite a widespread belief among doctors and patients that a strong sense of emotional well-being can improve survival in people living with cancer, multiple studies including this one refute such claims. Wrote the authors, "The belief that emotional well-being affects survival, nonetheless, has been remarkably resilient in the face of contrary data."

Anyone who has known a head and neck cancer patient might have reached this conclusion even without having read the story. In fact, they might just say, "You needed to collect quality-of-life surveys to figure this out? Have you ever seen what treatment for head and neck cancer does to you? The biggest surprise in your study is finding patients who weren't depressed." As a medical oncologist, I understand what our commenter is implying, viz., head and neck tumors are grievous and require particularly harsh treatment in order to eradicate them.

Nevertheless, I strongly support the sowing of hope and joy in the lives of my patients. The research data show that it won't make them live any longer than if they were depressed. I understand, and won't suggest that they will live a longer life with such an attitude - just a better one.

A happy life consists not in the absence, but in the mastery of hardships.
-Helen Keller


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Well, finally a study to show what common sence should tell you in the first place; you cannot laugh yourself out of cancer. It seems that since Norman Cousins wrote "The Anatomy of an Illness" this nonsence has taken center stage. It is even printed in the handout literature that we are given at our oncology offices. Granted, cancer patients are easier to be around if they aren't morose, and who wants to treat a sourpuss; but can't they spare us all the voodoo medicine?

Thanks for highlighting this study. It should be reassuring to patients that they don't have to keep a big smile on their faces all the time...One less thing about which to feel guilty.

One other issue, though, is the Quality of Life measurement. The FACT family of questionnaires is the best we have for QoL testing in cancer patients and survivors. Nevertheless, the instruments remain relatively crude. Researchers tend to throw a bunch of surveys at patients hoping to find something meaningful.

Finally, a study that tells the truth. I have always been disgusted with that positive attitude woo. Dr. A. did a post on this and I left my comment regarding my feelings on such poppycock. I'm a gentle soul, but that positive attitude nonsense has always drove me crazy. Survival is not in the patients hands.

No, patients shouldn't feel pressured into presenting a positive attitude when we don't feel that way. Anger and negativity have their place and can be useful tools. We deal with the good and the awful in good and awful ways but Dr. Hildreth isn't whistling Dixie when he stated that positive attitudes can help us live a better life.

not an endorsement of the pollyana complex

Pasting on a smile and keeping a stiff upper lip when I'm being told things like my eyebrows and eyelashes will fall out also, or that my cancer has returned and is expected to be a virulent as the first bout isn't really improving either my attitude or my quality of life. If I feel the need to cry, I should be allowed that priviledge, so long as it isn't the normal way in which I conduct my day. And if it is, then a compassionate shoulder goes a lot farther than a warning that I may be causing my cancer by my attitude.

I am all in favor of the Norman Cousins laugh your way to health scheme. Even if it doesn't work it gives you something to do in those last months of your life, and its cheaper than homeopathy with the same level of risk.

First, I would like to say that I found your post and links quite informative. It is interesting that cancer patients who have a positive outlook on life are no more likely to survive than patients who are depressed. I would have thought otherwise. The studies could not find significant evidence to link positive attitude to a better outcome in cancer survival. As you have in your post, I would also ask, �Are they telling us that all this �keep your head up� advice given to cancer patients is worthless?� I believe that staying positive will benefit a cancer patient mentally and physically. In general, maintaining a good attitude helps everyone. I would like to point out that the information presented in the study conducted by James C. Coyne, Ph.D. and colleagues is exclusively representative of patients with head and neck cancer. Therefore, patients diagnosed with other cancers, such as breast and prostate cancer, may benefit from having a positive attitude. As stated in the referenced article �Emotions Don�t Play a Role in Cancer Survival,� the role of endocrine factors associated with breast and prostate cancer may yield varying results. Do you believe that the outcome would differ for patients with breast and prostate cancer in comparison to those with head and neck cancer? As a future physician, I would also �strongly support the sowing of hope and joy in the lives of my patients.� Since multiple studies �[do not] suggest that they will live a longer life with such an attitude,� patients have to know that they will just live a �better one� as you concluded. Are there any studies which oppose the notion that positive emotions do not play a role in cancer survival outcomes?