John McCain is a fighter, no question. But can attitude affect cancer?
Military metaphors are commonplace when people talk about cancer — or should we say the "fight against cancer." Since John McCain announced his brain cancer diagnosis, the senior senator from Arizona has received a barrage of supportive statements featuring martial language.
Politicians and other well-wishers have explicitly connected his war hero reputation with a favorable outcome. "Cancer doesn't know what it's up against," former president Barack Obama tweeted.
Vice President Pence wrote: "John McCain is a fighter & he'll win this fight too." McCain's daughter Meghan posted a tribute on Instagram, saying: "Cancer may afflict him in many ways: But it will not make him surrender.
Nothing ever has." On television, newscasters discussing McCain's diagnosis talked up his toughness, too. "There is nobody who is the kind of fighter that John McCain is," said CNN's Dana Bash.
"Never mind all of the things that he went through in Vietnam, the melanoma that he had in 2000. But just even the extent to which he is going constantly, in warp speed always.
. . . He has a fighter pilot's mentality." There's no denying McCain's fortitude. It was on full display this past week, when he bucked his party to block the repeal of the Affordable Care Act.
But can personality traits alter the course of cancer, as his well-wishers seem to want to believe? Can a positive mental stance tame an aggressive malignancy such as glioblastoma ? As a doctor and cancer survivor, I know there is no evidence to support the idea that personality can influence the growth of malignant cells.
There is no cancer for which attitude can halt the progression of disease. And, despite medical progress against other tumors, glioblastoma remains lethal.
Even with treatment, patients have a slim chance of living long with this condition; the five-year survival rate is just over 5 percent. Ted Kennedy (D-Mass.) and former vice president Joe Biden's son Beau died within two years of diagnosis.
Still, the words of support for McCain shouldn't be written off as empty platitudes — phrases that belong on Mylar balloons, as the Atlantic's James Hamblin suggested. Language can be a powerful tool in medicine.
As with physical remedies, there are potential harms and risks to consider, but potential upsides, too. The questionable relationship between cancer and psychological traits has percolated through scientific and popular literature for decades.
In her landmark 1978 essay, "Illness as Metaphor," Susan Sontag railed against the view, popularized by psychoanalyst Wilhelm Reich, that cancer is "a disease following emotional resignation — a bio-energetic shrinking, a giving up of hope." Sontag wrote: "Widely believed psychological theories of disease assign to the luckless ill the ultimate responsibility both for falling ill and for getting well.
And conventions of treating cancer as no mere disease but a demonic enemy make cancer not just a lethal disease but a shameful one." She rejected these notions.
Modern researchers have debunked the idea that negative emotions heighten an individual's susceptibility to developing cancer, or that maintaining a positive outlook can stave off cancer's return or delay its progression.
As Jimmie Holland, a psychiatrist at New York's Memorial Sloan Kettering Cancer Center, has said, "The idea that we can control illness and death with our minds appeals to our deepest yearnings, but it just isn't so." In 2007, the Radiation Therapy Oncology Group confronted the belief that psychology affects cancer patients' survival.
This well-established clinical-trials organization studied more than 1,000 patients with head and neck cancers. After controlling for tumor stage and demographic factors, such as income, the researchers found no relationship whatsoever between patients' outcomes and their emotional well-being.
Another informative, large study drew on personality questionnaires completed by nearly 60,000 Swedish and Finnish people. Years later, investigators identified 4,631 cancer cases among the participants.
In 2010, they reported that neither "extraversion" nor "neuroticism" increased the likelihood of a cancer diagnosis or survival after a cancer diagnosis.
Although a handful of studies have found that women who are anxious or depressed are more likely to suffer recurrences of breast cancer and die from the condition, it's plainly true, and understandable, that dying women are more likely to be anxious and depressed.
These analyses are confounded by the fact that attitudes influence patients' treatment decisions: their willingness to participate in clinical trials, try new drugs, seek second opinions and travel for their care.
What's more, social determinants of health — education and economic circumstances — can mask what might be construed as grit or a fighting spirit. Many people cannot afford to try new cancer medications or seek multiple opinions.
In some disadvantaged communities, fatalism about cancer affects whether patients get screened, go for checkups upon noticing worrisome symptoms or, even after a diagnosis, accept care provided by oncologists.
Meanwhile, some doctors and advocacy groups worry about the potential harms of applying battle language to the experience of having cancer. Patients may feel they are to blame if they fail to "beat" the tumor.
They may think that their recurrence, or impending death, is not due to the nature of their malignancy but a failure of will. An added concern is that military language and tales of courage can discourage acceptance of palliative care.
Patients may become trapped by a positive mentality — pressured by family and friends who encourage them to keep trying more treatments, or compelled by an internal drive to fight to the end — and they may push themselves beyond what's sensible or realistic.
Yet I recall some of my patients who liked to say they were "fighting" cancer. So did my father, who lived with lymphoma for three decades before dying at age 83 from a pancreatic tumor.
When I received my own breast cancer diagnosis, in 2002, I didn't think of it in terms of battle language. I'm not a military-oriented person; although I aspire to mental fortitude, fighting words don't suit me.
However, I accept that just as some people derive strength and comfort in prayer and others don't, patients' responses to words, images and stories about cancer do vary.
Recent research suggests that participating in support groups can reduce cancer patients' anxiety, fatigue and depression.
Không có nhận xét nào:
Đăng nhận xét