Emotion and Cancer Survival

There is some research coming out in the December issue of the journal Cancer from some researchers at the University of Pennsylvania School of Medicine and other colleagues. The results surprised me, particular since I know some of the authors, and they are first rate investigators.

For over thirty years, most research studies have claimed to find an association between emotions, attitudes and beliefs, and the chance of survival form several types of cancer. Entire psychological wellness and psychotherapy programs have been designed around that premise.

The study suggests that emotional wellbeing has no effect on the chances of surviving head and neck cancer. People with negative emotions had the same survival rate as people with positive emotions.

Patients from two Radiation Therapy Oncology Group clinical trials completed a quality of life questionnaire known as the Functional Assessment of Cancer Therapy-General (FACT-G) at the start of the trials. So these assessments were added on to studies of different cancer treatments. One trial was looking at what is known as “dose fractionation strategies” and the other was looking at combined chemotherapy and radiation treatments.

The FACT-G questionnaire included a collection of items called the Emotional Wellbeing Scale. This was assessed against overall survival.

There were 1,093 at the start of the trials, of whom 646 died during the period of the study. One of the reasons for trusting the data is that this large sample together with the consistency in the treatment the patients received have made this study one of the most statistically robust ever conducted.

Emotional state did not predict survival, and the results did not change when the researchers took into account possible effects such as interactions between emotional wellbeing and the methods of the study, gender, the primary site of the cancer, or the stage of the cancer.

There are several important points:

• The study only included head and neck cancer patients. These are often very traumatic cancers, but they do not usually involve the endocrine system. Some of the best data on emotions and survival come from studies of breast cancer, which often involves disturbances of hormones that may themselves have an impact on mood and survival. And mood can have a big impact on hormones
• The patients in the study had to keep coming to appointments, and to follow instructions, so they may not be representative of all people with head and neck cancer

But the most important thing is this: before critics jump off the deep end, let’s be very clear.

The study is not saying that having an optimistic or positive emotional outlook does not bring benefits to cancer patients. All it is saying is there is no evidence that it prolongs life.

Psychotherapy, art therapy, bibliotherapy and many others can all provide a great many emotional and social benefits.

They may not add anything to the years that a persons lives, but they may add greatly to the life in those years.

Comments

[Andy Hunt]

Those weren't the results most people would have expected (except perhaps hardened sceptics).

I had a look at the FACT-G scale expecting to find an extensive inventory of a persons emotional and psychological state and found just 6 questions.

That seems like a bit of a blunt instrument to explore all the psychological and emotional facets of the cancer experience. A little more investigation might be required before writing off emotional wellbeing as a factor in survival.

Even if it turns out that there is no correlation between emotional wellbeing and survival rates, I'd rather be contented than not for what time remains. That's true regardless of whether I have cancer or not. After all life is a temporary arrangement for all of us. It's about quality of life not quantity.