A new US study suggests that emotional wellbeing has no effect on the chances of surviving head and neck cancer. People with so called negative emotions had the same survival rate as people with positive emotions, the researchers found.
The study is to appear in the 1st December issue of the journal Cancer and is the work of researchers at the University of Pennsylvania (Penn) School of Medicine and other colleagues.
Lead author of the study, Professor of Psychology in Psychiatry at Penn, and Co-Leader of the Cancer Control and Outcomes Program at the Abramson Cancer Center, also at Penn, Dr James C Coyne said that:
“The belief that a patient’s psychological state can impact the course and outcome of their cancer is one that has been prominent among patients and medical professionals, alike.”
“This belief leads people to seek psychotherapy in the hopes of promoting survival. While there can be lots of emotional and social benefits of psychotherapy, patients should not seek such experiences solely on the expectation that they are extending their lives,” advised Coyne.
Patients from two Radiation 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. One trial was looking at 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.
The total number of patients in the sample was 1,093 at the start of the trials. Of these 646 died during the period of the study. The authors said that the large sample together with the consistency in the treatment the patients received made this study one of the most statistically robust ever conducted in this field.
The results showed that emotional status was not a significant predictor of survival in the sample. Also, this finding did not vary when the researchers took into account possible confounding 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.
Coyne and colleagues concluded that:
“This psychologic variable neither affected progression or death directly, nor functioned as a lurking variable. The current results add to the weight of the evidence that emotional functioning is not an independent predictor of survival in cancer patients.”
Coyne said that while this study “may not end the debate, it does provide the evidence to-date that psychological factors are not independently prognostic in cancer management”.
One potential drawback of this study, notwithstanding its robustness, is that it only included head and neck cancer patients. These cancers do not involve the endocrine system to the same extent as other cancers such as breast and prostate cancers, so it could be argued that the results from this study don’t necessarily apply to other cancers. But the authors were inclined to disagree, citing similar findings from large studies on both metastatic and nonmetastatic breast cancer.
Another potential limitation the authors readily admitted to was that in order to take part in the trial, the participants had to show they could be relied on to keep appointments, follow instructions, and understand and give informed consent. This means the sample was not truly representative of all people who may have head and neck cancer.
It is important to point out that this 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.
“Emotional well-being does not predict survival in head and neck cancer patients: A radiation therapy oncology group study.”
James C. Coyne, Thomas F. Pajak, Jonathan Harris, Andre Konski, Benjamin Movsas, Kian Ang, Deborah Watkins Bruner.
Cancer Published Online: 22 Oct 2007.
DOI: 10.1002/cncr.23080
Written by: Catharine Paddock