It's almost an article of faith: your best ally in the fight against cancer is a doggedly optimistic outlook. And it would seem that mounting evidence of the links between emotional and physical well-being would bolster that view. The only problem, says Dr. Jimmie Holland, a psychiatrist at Memorial Sloan-Kettering Cancer Center in New York City, is that there is no good evidence to support that belief when it comes to cancer. Moreover, the "tyranny of positive thinking," as she calls it, often becomes just one more burden for the afflicted. Cancer patients shouldn't feel obliged to smile through their suffering. More critically, she says, "they shouldn't have to feel guilty if their treatment fails."
It was research in the 1970s and '80s that first popularized the idea that attitude might affect cancer outcomes. Such research led doctors to encourage patients to think happy thoughts and visualize their immune system blasting away tumor cells. But most of those studies have been dismissed as either flawed or inconclusive. A review of 37 studies that was published in the British Medical Journal in 2002 found that although a positive outlook does correlate with the perception of less pain by patients--a real benefit--there is "little consistent evidence that coping styles play an important part in survival from or recurrence of cancer."
Still, the optimism theory remains seductive. One reason is that Americans live in a culture that covets control. We want to believe that we can beat cancer by imposing our will on the disease. A better reason is that mental states like depression and chronic anxiety have been shown to have physical consequences that affect the progression of such illnesses as heart disease and diabetes. While a similar connection is biologically plausible for cancer, it is far from proven.
Even researchers who believe that studies will ultimately establish links between stress and the progression of cancer, like Stanford's Dr. David Spiegel, know the picture is complex. "It isn't a matter of 'Fix it in your mind, and you fix it in your body,'" he says, "but it would be strange if what goes on in our minds didn't affect how our bodies deal with illness."
So where does that leave cancer patients? Doctors know that individuals will always bring their own disposition--sunny, sour or sarcastic--to bear on their illness and treatment. Pressuring them to be paragons of positive thinking is futile. Worse, it could cause them to hide their fears and shun support. But clinicians must remain alert for signs of depression, which can affect the outcome of any disease if it interferes with treatment. And many patients will also need--and welcome--help to improve poor coping skills. Spiegel says, "Having worked with people with life-threatening illnesses for 30 years, it's clear that there are better and worse ways to deal with these things." False optimism isn't helpful, but neither is despair. --By David Bjerklie