The chief of psychiatry at New York's famed Memorial Sloan-Kettering Cancer Center says Americans place a "terrible burden" on themselves and their families when they conclude that something in their own personality has brought on or worsened their cancer.
The burden is unfair and unsupported by facts, said Dr. Jimmie C. Holland. "It's enough to get cancer without thinking you brought it on yourself."
So far, she said, there is no conclusive evidence that our state of mind has any power to cause cancer or to change its outcome. "There is something in the American personality that says if we all live right, we can live forever," Dr. Holland told Sinai Hospital's first national cancer symposium last week in Baltimore.
"Our hope would be that there is some . . . psychological intervention that would be of help to people in their survival," she said. Scientists are looking, "but the issue is still an open one."
The only known, direct link between a patient's state of mind and the outcome of his cancer, she said, "is if their state of mind leads them to stop treatment."
Many patients and their families nevertheless seek out "alternative" therapies to help change their attitudes in a "fight" to get well. Those who don't change risk the anger of family members who feel they're "giving up."
In a review of the available research on the role of psychology in cancer, Dr. Holland said patients living in poverty, with low educational levels and without mates or other social ties, do have higher mortality rates from cancer. But she said poor access to medical care, not their mental state, is probably to blame.
"There is not a personality type that gets cancer," she said, "and there is not any coping style that predisposes them to having cancer. It does not appear as if stressful life events, like grief, cause cancer to develop."
Likewise, there is no unchallenged evidence that anger, a "fighting spirit," depression, or grief will change the outcome of the disease. "There is no correct way to face cancer," Dr. Holland said.
But that's not to say there is no link at all between cancer and the way we live our lives.
People can reduce their cancer risks by avoiding diets high in fat and low in fiber, smoking, alcohol consumption and prolonged exposure to the ultraviolet radiation in sunlight.
"The second thing that people can do, very clearly, is to be alert to the early signs of cancer, and once you know you have it, to adhere to your treatment," she said.
There is also some curious evidence from two studies that some people can somehow postpone their death from cancer until after a "symbolic occasion," such as a religious holiday.
What scientists really want to know, however, is whether there are predictable ways to affect the outcome of cancer through psychology.
One "intervention" that is now intriguing scientists, Dr. Holland said, is psychological support through group therapy.
There is evidence, she said, that psychological support "clearly helps people reduce stress and improve their sense of well-being, and also comply with treatment. . . .
"There is no downside to psychological support," she said. Conventional medicine doesn't do enough of it, and "It should be more available than it is."
But can group therapy actually prolong life?
"We have one study that suggests that [group therapy] might have some effect on survival," she said.
The lone study, reported in the British journal Lancet in 1989, found that interventions to improve breast cancer patients' sense of well-being also had a positive effect on mortality rates.
No one knows why that might be. Other studies have found no such effects on mortality, but have found that psychological intervention can produce subtle changes in the immune system. Might those changes increase survival rates?
Researchers are now exploring chemical links between the brain, the endocrine system and the immune system for more clues.
"But what this means in relation to cancer is unknown," Dr. Holland said.