Here is an interesting article
From Medscape Medical News >
In Cancer Survival, 'Mind Matters,' Says Expert
End of life is most relevant
Authors and Disclosures
February 2, 2011 — Social support and psychologic/psychiatric
interventions can improve survival in cancer but are "overlooked" in
the treatment of the disease, argues a psychiatrist in an essay
published in the February 2 issue of the Journal of the American
Dr. David Spiegel
"A patient's personal mental management of the stresses associated
with cancer" is a "natural ally" in the battle with this disease,
writes David Spiegel, MD, from the Department of Psychiatry and
Behavioral Sciences at Stanford University School of Medicine in Palo
"It is plausible that interventions providing emotional and social
support at the end of life have a positive influence on physiological
stress-response systems that affect survival," he writes, suggesting a
mechanism of action.
But another expert in the field of noted that
there is very little evidence of such survival benefit.
"Social support almost certainly makes people feel better, which is
hugely important, and I wouldn't be surprised if it did improve
survival," said Richard Sloan, PhD, from the Division of Behavioral
Medicine at the in New York City.
But, he added, there is no strong body of evidence that treatments and
services addressing social or emotional issues improve survival in the
field of cancer.
For instance, "I know of no study in that shows that
reducing depression improves survival," he said. "We should treat
depression because it makes patients miserable, not because we think
it may improve survival," he added.
Dr. Sloan's great concern about the discussion of the evidence
regarding psychosocial support and cancer survival is how the
information is received by the public, most importantly cancer patients.
"We have to be really careful not to oversell the interventions we
have," he told Medscape Medical News. The reason? "People can feel at
fault if they don't respond to a program," he said. In a recent
editorial in the New York Times, Dr. Sloan discusses some of the
history of "mind cure" movements in the United States. The editorial
touches on the lack of scientific validity in the belief that
personality or "a way of thinking" can influence disease outcomes. As
he notes, a recent large study dismissed the idea that any personality
type is associated with the risk of getting or surviving cancer.
Dr. Spiegel does not say that cancer can be cured by psychosocial
interventions and makes no claims about the power of positive
thinking. Instead, he argues that psychosocial support, which includes
the discussion of death and learning how to manage pain and anxiety,
might extend survival, particularly at the end of life. He summarizes:
"It is not simply mind over matter — but mind matters."
Follows Palliative Care Study
Dr. Spiegel's essay comes about 6 months after a study on in cancer was published in the New England Journal of Medicine
(2010;363:733-742). In that study, the introduction of palliative care
— a program designed to minimize pain and improve quality of life — at
diagnosis, in parallel with standard oncologic care, was associated
with a significant improvement in survival in patients with metastatic
nonsmall-cell lung cancer (NSCLS).
After discussing the palliative care study in his essay, Dr. Spiegel
states that "there is increasing evidence that social support affects
survival [in cancer]." He cites 2 studies in particular: a study in
women with early-stage breast cancer, which was led by Barbara
Andersen, PhD, from Ohio State University in Columbus (Cancer.
2008;113:3450-3458); and a study by Dr. Spiegel himself in women with
To Medscape Medical News, he mentioned 3 other randomized trials and 1
matched-cohort trial that "have found that psychosocial treatment for
patients with a variety of cancers produced both psychological and
survival benefits." The cancers in these types of studies tend to be
those with the poorest prognosis, including , NSCLC,
, and gastrointestinal tract cancers, Dr. Spiegel points out
in his essay.
"For breast and other cancers, when aggressive antitumor treatments
are less effective, supportive approaches appear to become more
useful," observed Dr. Spiegel.
Dr. Andersen said that the quantity of cancer research that indicates
a survival benefit of psychosocial interventions is not abundant.
"There is not all that much data on social support in particular," she
told Medscape Medical News.
Nonetheless, Dr. Andersen suggested that the palliative care study
represents a pivotal moment in this area of research. The fact that
the New England Journal of Medicine published it was "quite amazing,"
she said. The journal has a "history of considerable skepticism with
regard to the importance of psychological and behavioral factors in
cancer," she explained.
Dr. Andersen also pointed out that "there's a whole lot more going on
in psychosocial interventions than just social support." For instance,
in her breast cancer study, she and her colleagues note that the
intervention was psychologist led, conducted in small groups, and
included strategies to reduce stress, improve mood, alter health
behaviors, and maintain adherence to cancer treatment and care.
Therein lies a problem, said Dr. Sloan. "It's hard to know which is
the active agent" in such multifactorial studies. For instance, he
wondered whether treatment adherence was the element of the Ohio State
program that tipped the scale toward a survival benefit.
Dr. Andersen responded that adherence was not a factor in the
Dr. Andersen would like the discussion about the benefits of
psychosocial interventions and drug therapies and other treatments to
not be a matter of "either/or." The various interventions should work
together, she said.
The authors have disclosed no relevant financial relationships.
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