Mind matters in cancer survival

摘要: The field of psycho-oncology is hung up on the hyphen in its name. How do we understand link between mind and body? Is that merely an arrow to left, indicating cancer body affects mind? Can it be right as well, affecting course cancer? We know social support survival, 1 including with cancer.2 Also, people tend die after rather than before their birthdays major holidays.3,4 Depression worsens survival outcome cancer.5,6 Yet have been understandably delicate about mind-body influence, not wanting claim too much, or provide unwitting for overstated claims wishing away picturing white blood cells killing would actually it. That a connection, superhighway. our desire respected members oncology community often minimized natural ally battle against – patient’s physiological stress coping mechanisms. Even at end life, helping patients face death, make informed decisions level care, controlling pain distress only humane but appears medically more effective simply carrying intensive anti-cancer treatment alone.7 A recent randomized clinical trial palliative care non-small cell lung patients8 makes case strongly. authors reported clear apparently paradoxical finding: “Despite receiving less aggressive end-of-life group had significantly longer those standard (median 11.65 vs. 8.9 months; P=0.02)” (p. 738). Those became depressed well. condition consisted average 4 visits focused choices resuscitation preferences, control, quality life. study suggests life most treatments may effective, psychologically, also medically. How could living better lead longer? When began investigate effects groups 1970’s, others were concerned watching same disease demoralize patients, might even hasten death. evaluated mood discussion content minute-by-minute determine whether bad news other was despressogenic. found these women advanced breast talked seriously death dying, showed no signs depression panic.9 Indeed initial studies, confirmed by many others, indicated reduced pain.10,11 But now results are showing something profound feeling better, they facing helps live cancer. 1989 demonstrating metastatic year weekly therapy lived 18 months control difference due differences severity subsequent chemo- radiotherapy. result this 10 study, cited last count Google Scholar 2,222 times, first greeted great excitement later skepticism. Now 21 years later, findings being confirmed. A decade conducted IRB-approved replication overall effect similar significant interaction tumor type, such estrogen receptor negative cancers who did ER alone.12 While disconfirmation hypothesis together improve advances hormonal chemotherapies improved interim.13 However, tumors largely excluded from benefit treatments, which account findings.13 Further explanation comes fact cohorts has over decades (See Figure 1). Figure 1 Comparison Survival across 3 Spiegel Metastatic Breast Cancer Studies More recently, psychoeducational primary both rates relapse survival. 14,15 In addition this, original study16, referred above,8 three published psychotherapy trials17–20 one matched cohort trial21 psychosocial variety enhanced psychological Table 1). six 22–27 four involving patients,24–27 treated psychotherapy. 2) Three studies emotional interventions,23–25 making unlikely. another multicenter trial,26 Supportive-Expressive Group Psychotherapy reduce depression, odd thing begin with, medical prognosis worse baseline.6 Furthermore, all random: show gathering directing attention expression mortality shortens survival.28 Table 1 Randomized Trials Showing Benefit Psychotherapy Table 2 Randomized No Psychotherapy The provocative discordant occurred cancer, where positive human epidermal growth factor 2-positive (HER2+) substantially. Among poorer prognosis, malignant melanoma, leukemia, gastrointestinal cancers, seems extend Patients targeted highly chemotherapeutic approach obtain apparent biomedical interventions. Thus, especially settling anti-tumor efficacious, supportive approaches become useful. One think least yet observation involved By time someone dies usually kilogram body. when body’s resources well matter most.