YOU CAN’T CURE CANCER WITH UNICORNS AND RAINBOWS
First, I want to share
an advice “column” from a philosopher I encountered in a Podcast. I sent him a
question on the topic at hand. He dropped everything to write this for me (and
my tribe) and I will be forever thankful.
It has been quite the
week in the metastatic breast cancer (MBC) social media world with much debate
around the role of being positive and cancer survival. It started when someone
claimed that MBC is not a death sentence! I beg to differ. It IS a death
sentence. Just ask any of us about the last two months; so many wonderful women
died much too young leaving children and spouses behind. Or didn’t even have the
opportunity to have children. Yes, we are getting cynical. A friend was even told that someone hopes she dies alone in misery for not having a positive attitude.
It remains that 113
people die each day in the US and the median life expectancy is only 3 years. That
is NOT a chronic disease. Saying this detracts from URGENCY for a cure. As I’ve
said before to all the research groups and charities – you cure metastatic/Stage
4, you cure breast cancer!
I understand when
people tell me I am still here because of my attitude, spirit, etc. I know you
come from a place of great compassion. But the down side is that this puts
pressure on all those that continue to progress then die no matter how positive
they were, how strong their faith was, or how “healthy” they lived their lives.
I got lucky with Her2 having great science and research behind it. It’s also
not true. I may appropriate the image of good attitude, spirit, lifestyle etc. But
honestly, I’m cynical, moody, and challenging to live with for many. You only
get to see the 10-25% of my time when I am “feeling good.” Yes, I like to be
looked up to and encouraged. But I’d rather cure my friends.
There was a great
divide in MBC this week on the topic of “being positive.” Most of the people perceived
as powerful advocates preferred a feisty attitude and embraced the tough parts
(reality) of cancer. I agree. It’s awful for most. Has any rights movement –
feminism, civil rights, AIDS, LGBTQA+ - ever been achieved without anger and
even violence? While we don’t wish to use violence, we want to “fight” (but not
for our lives - BTW please refrain from using battle metaphors with me,
especially in my obit) for funding, research, timely and equitable access to
treatment….
Rather than writing up
my own take on the “Tyranny of Positivity” – I thought I’d dig up some evidence…and
this was barely scratching the surface. I also added a couple of great books
and this video by JP Sears on the Terrorism of Happiness https://www.youtube.com/watch?v=9w6EuO9MugE
·
Relationship between behaviour and
self-blame in breast cancer: Self-blame is related to anxiety and depression.
Feeling in control did not mediate self-blame (Bennet, Compas, Beckjord, & Glinder,
2005).
·
No link between personality and cancer.
Positivity had no influence on survival or even getting cancer. Psychotherapy
does not help one live longer. Mental health support is needed, though, for
quality of life (Jokela, et al., 2014).
·
Positive
attitudes may help some patients but it does not affect OS or PFS. Based on
most rigorous study. Emotional state of patients had no influence on survival.
There is no evidence for the popular notion that an upbeat attitude helps “beat”
cancer (Boyles, 2007).
·
A meta-analysis did
not find a difference in survival using psychosocial intervention (Chow, Tsao, & Harth, 2004).
·
Emotional functioning
does not predict survival in cancer patients (Coyne, et al., 2007).
·
No trials with survival as a primary endpoint using psychotherapy
showed a positive effect. Poor evidence is apparent in other studies about the effects
of psychotherapy on survival (Coyne, Stefanek, & Palmer, 2007).
·
Positive psychology is popular due to culture and values.
“Fighting spirit” does NOT extend life. Positivity
interventions do NOT improve immune system and cancer progression and mortality
(Coyne & Tennen, 2010).
·
Positive
psychological states and cancer outcomes are self-perpetuating with no empirical
evidence (Coyne, Tennem, & Ranchor, 2010).
·
Psycho-oncology is
reviewed with respect to stigma, mental illness. The impact of positive
psychology continues to add to the stigma. There is research about immunity and
psychological wellness (Holland, 2002). However, there is a lack of evidence (Coyne &
Tennen, 2010).
·
In brain tumour patients, self-blame was the greatest
predictor of depression and anxiety. (Hint – the whole CAM and positivity
movement is associated with self-blame.) A combination of coping strategies is
used by pts including "venting, acceptance, reframing, disengagement and
self-blame (p. 1421)." Illness perception does NOT play a role in positive thinking.
A balanced approach to coping may reduce depression and anxiety (Keeling, Bambrough, & Simpson, 2013).
·
Psychological health and cancer
survival is controversial and debated. Does living better result in living
longer? (Kissane, 2007)
·
In
Sweden and Finland, a very large study (almost 60,000 people) suggested
that personality was not associated with risk of cancer or OS in cancer (Nakaya et al., 2010).
·
Most often CANCER IS NOT YOUR FAULT: 66% of all cancer is related to RANDOM dna replication errors (Tomasetti
& Vogelstein, 2017).
·
Progression to metastatic IS NOT YOUR FAULT. Stem cells
for breast cancer often spread BEFORE a tumour in the breast even forms (Harper
et al., 2016; Hosseini
et al., 2016).
So no amount of UNICORNS,
RAINBOWS, and glasses half full are going to cure your cancer. Return to being
feisty advocates.
Disclaimer: If positive attitude works for you and helps you cope BY ALL MEANS use it as best you can.
Oh and metastatic breast cancer does NOT have a cure…that means it's not Stage 4/Metastatic (Canadian Cancer Society, n.d.).
Books:
Ehrenreich, B. (2009). Bright-sided: How the relentless
promotion of positive thinking has undermined america (1st. ed.). New
York: Metropolitan Books.
Holland, J. C., & Lewis, S. (2000). The
human side of cancer: Living with hope, coping with uncertainty (1st ed.). New York: HarperCollins.
References:
American Cancer Society (2014) Attitudes and cancer.
Retreived from https://www.cancer.org/cancer/cancer-basics/attitudes-and-cancer.html
Bennett, K. K., Compas, B. E., Beckjord, E.,
& Glinder, J. G. (2005). Self-blame and distress among women with newly
diagnosed breast cancer. Journal
of Behavioral Medicine, 28(4),
313-323. doi:10.1007/s10865-005-9000-0
Boyles S. (2007) Positive
attitude doesn’t whip cancer? Patients’ positive thinking has no impact on
cancer survival, study shows. WebMD. Retreived from www.webmd.com/cancer/news/20071022/positive-attitude-doesnt-whip-cancer
Canadian Cancer Society (n.d.) Treatments for stage IV breast cancer. Retrieved from http://www.cancer.ca/en/cancer-information/cancer-type/breast/treatment/stage-iv/?region=bc
Chow, E., Tsao, M. N., & Harth, T.
(2004). Does psychosocial intervention improve survival in cancer? A
meta-analysis. Palliative
Medicine, 18(1), 25-31.
doi:10.1191/0269216304pm842oa
Coyne, J. C., Pajak, T.
F., Harris, J., Konski, A., Movsas, B., Ang, K., . . . Radiation Therapy Oncology Group. (2007).
Emotional well-being does not predict survival in head and neck cancer
patients: A radiation therapy oncology group study. Cancer, 110(11), 2568-2575.
doi:10.1002/cncr.23080
Coyne, J. C., Stefanek, M., & Palmer, S.
C. (2007). Psychotherapy and survival in cancer: The conflict between hope and
evidence. Psychological
Bulletin, 133(3), 367-394.
doi:10.1037/0033-2909.133.3.367
Coyne, J. C., & Tennen, H. (2010). Positive
psychology in cancer care: Bad science, exaggerated claims, and unproven
medicine. Annals of Behavioral Medicine : A Publication of the Society
of Behavioral Medicine, 39(1), 16-26. doi:10.1007/s12160-009-9154-z
Coyne,
J. C., Tennen, H., & Ranchor, A. V. (2010). Positive
psychology in cancer care: A story line resistant to evidence. Annals
of Behavioral Medicine, 39(1), 35-42. doi:10.1007/s12160-010-9157-9
Harper, K. L., Sosa, M. S., Entenberg, D.,
Hosseini, H., Cheung, J. F., Nobre, R., . . . Aguirre-Ghiso, J. A. (2016).
Mechanism of early dissemination and metastasis in Her2+ mammary cancer. Nature, 540(7634), 588-592.
doi:10.1038/nature20609
Holland, J. C. (2002). History of psycho-oncology: Overcoming
attitudinal and conceptual barriers. Psychosomatic Medicine, 64(2), 206-221.
doi:10.1097/00006842-200203000-00004
Hosseini, H., Milan M S Obradovic, Hoffmann,
M., Harper, K. L., Sosa, M. S., Werner-Klein, M., . . . Klein, C. A. (2016).
Early dissemination seeds metastasis in breast cancer. Nature, 540(7634), 552-558.
doi:10.1038/nature20785
Jokela, M., Batty, G. D., Hintsa, T., Elovainio, M., Hakulinen,
C., & Kivimäki, M. (2014). Is personality associated with cancer incidence
and mortality? an individual-participant meta-analysis of 2156 incident cancer
cases among 42,843 men and women. British Journal of Cancer, 110(7), 1820.
doi:10.1038/bjc.2014.58
Keeling, M., Bambrough, J., & Simpson, J. (2013).
Depression, anxiety and positive affect in people diagnosed with low‐grade
tumours: The role of illness perceptions. Psycho‐oncology, 22(6), 1421-1427. doi:10.1002/pon.3158
Kissane, D. W. (2007). Letting go of the hope that psychotherapy
prolongs cancer survival.Journal of Clinical
Oncology : Official Journal of the American Society of Clinical Oncology, 25(36), 5689-5690.
doi:10.1200/JCO.2007.13.9451
Nakaya, N., Bidstrup, P. E., Saito-Nakaya, K., Frederiksen, K.,
Koskenvuo, M., Pukkala, E., . . . Johansen, C. (2010). Personality traits and
cancer risk and survival based on finnish and swedish registry data. American
Journal of Epidemiology, 172(4),
377-385. doi:10.1093/aje/kwq046
Tomasetti, C., Li, L., & Vogelstein, B.
(2017). Stem cell divisions, somatic mutations, cancer etiology, and cancer
prevention. Science, 355(6331), 1330.
doi:10.1126/science.aaf9011
Comments
Post a Comment