Should Patients Be Advised to 'Think Positive'?

During the course of one’s lifetime, an individual goes through a mix of emotions: happy, sad, mad, glad...When a patient receives a cancer diagnosis, they might feel frightened or overwhelmed. They might find themselves thinking: did I bring the cancer on myself? Are my emotions tied to the results of my treatment? Can positive thinking cure my cancer? The subject of maintaining a positive attitude during cancer treatment is one that comes up time after time. For some patients, a positive attitude is defined as being optimistic and able to get through every day events by taking control of one’s life in the present, rather than focusing on the future. For others, however, a positive attitude at a time of crisis may be insulting – making them feel guilty about experiencing negative emotions.

For several years, there was a time when it was believed that individuals with particular personality traits were more likely to be diagnosed with cancer. The most common belief was that neurotic individuals were at highest risk of getting cancer. Moreover, it was believed that personality changes affected the results of the cancer treatment. To date, there is no evidence to support this idea, only a few findings from smaller and not well-controlled studies. In 2010, the largest scientific study – taking into account 60,000 individuals over the course of 30 years – was published. The study looked carefully over factors such as alcohol consumption, smoking, as well as other known risk factors of cancer. It revealed no association between personality traits and overall risk of cancer / cancer survival.

When it comes to coping with a cancer diagnosis, the most important thing is to be able to recognize one’s thoughts and emotions. As a doctor, you are likely aware that there is no proof to back the idea that psychosocial interventions (treatment that deals with emotions and relationships) can help cancer patients improve their health, feel more energized or live longer. Still, interventions such as mindfulness, relaxation techniques, individual therapy, and group therapy can be used to alleviate distress and help cancer patients cope with their emotions – both the positive and the negative.

The power of positive thinking and cancer
Positive thinking is a mental and emotional attitude that focuses on positive thinking affirmations. A positive individual foresees happiness, health, success, and believes that he or she can overcome any obstacle that life throws their way. The power of positive thinking is not a notion that every individual believes in or for that matter, follows. Some accept it and believe in its effectiveness, while others consider it as nonsense.

Cancer patients are often told that their state of mind can make all the difference. While it is true that negative emotions can sometimes be harmful, leading patients to be less open, hard-headed, and difficult to communicate with; they should not feel dismissed if their emotions are not positive enough. Cancer patients and their families may feel accountable for their emotional reactions to the illness and feel pressured to think positive. Striving to ignore these emotions may make patients blame themselves when they cannot stay positive and worsen their emotional pain. At the same time, most patients want to believe that positive thinking can help control severe diseases and in some ways it can. While it cannot reduce the risk of cancer or prevent cancer recurrence, positive thinking is a comforting belief that can make cancer patients feel better and stay motivated to keep on fighting.

In one particular research study, researchers looked at the emotional health of over 1,000 patients with neck and head cancer. The objective of the study was to learn about the impact that attitude can have on cancer survival rates. Upon receiving the results, the researchers found that those who portrayed positive emotional health showed no distinctions in tumor growth or time-span of life, in comparison to those with lower, more negative emotional health. Based on how cancer develops and the risk factors associated with the disease, there is no belief that emotional health can lead to cancer or trigger its growth.

Psychotherapy and cancer
Psychotherapy, also known as talk therapy, is a way to help individuals deal with a broad variety of emotional hardships or mental illnesses. It can take on several different forms: cognitive behavioral therapy, mindfulness-based cognitive therapy, psychodynamic therapy, psychoanalysis, or a combination. Psychotherapy can help to eliminate or at the very least control troubling symptoms so that individuals can improve their overall attitude and well-being.

When the last few years, research has shown that providing cancer patients with information in a support group setting can help relieve their levels of anxiety, stress, and tiredness. This is because in such a setting, they can talk to other survivors, learn from them, and share their own experiences without feeling guilty or judged. Cancer patients may feel less lonely, knowing that others are going through the same experience they are. Throughout the years, several studies have been conducted in terms of psychotherapy and cancer survival rates. To date, there is no evidence to support the fact that mental health therapies can help cancer patients live longer. Still, it is evident that support groups can greatly impact individual’s overall quality of life. Psychological support should allow the patient to come to terms with his or her individual situation in a way that works best for them, within a caring and realistic environment. However, in no way should psychological support add to the emotional burden of the patient.

There is no doubt about it: cancer affects the body and it also affects emotions and feelings. Cancer patients’ attitudes, emotions, moods tend to change on a day to day basis, if not hour to hour. Sometimes, mental state of health and emotional support may be just what your patients’ need in order to get through difficult times. Mental health treatment as a type of cancer treatment will not advance or eliminate cancer growth; however, it may be an approach towards helping cancer patients and their loved ones adjust to the cancer diagnosis and progress forwards with their lives. As a doctor, you have the chance to talk with members within your cancer team about how you can best help cancer patients manage their disease and treatment. You may even want to consider getting some additional assistance from a partner support group or mental health professional, in order to help cancer patients cope better.

Can a positive attitude cure cancer?
Does positive thinking hold merit when it comes to a severe illness such as cancer? “No, I think it's not true. It's not true. In a spiritual sense, a positive attitude may help you get through chemotherapy and surgery and radiation and what have you. But a positive mental attitude does not cure cancer – any more than a negative mental attitude causes cancer” said Siddhartha Mukherjee, assistant professor of medicine at Columbia University and staff cancer physician at Columbia University Medical Centre. By forcing positive thinking, you are not allowing your patients to face reality. Every individual is different and for some patients, sadness, anxiety, and fear are normal parts of the grieving process. It may be their way of learning to cope with changes in life. Still, a positive attitude may be appropriate as a coping strategy. “On the plus side, the studies that debunk positive thinking deal with very sick patients struggling to recover from major diseases. They do not comment on how positive thinking might prevent disease or how it might affect someone in the very early stages of illness. The real point isn't to rescue a dying patient but to maintain wellness... The upshot is that medicine cannot be definitive on how mood affects wellness. But if I wanted to enhance a state of wellness before symptoms of illness appeared, there is much to be gained and no risks involved in trying to reach the best state of mind possible” said Dr. Deepak Chopra. It may be a way for cancer patients to find the strength and support that they need in order to feel better and experience the best quality of life – despite their illness.