What you believe may not be good for you

A study by researchers at the University of Miami and Yale School of Medicine suggests there may be an association between patients’ beliefs about the potential curability of prostate cancer and their overall, long-term survival.

Soler-Vilá et al. were able to use long-term data from 251 men initially diagnosed between 1987 and 1990 and monitored for mortality for up to 15 years. Their study was designed to explore how patients’ beliefs about the efficacy of regular checkups for detection, the potential “harms” of treatment, and the perceived curability of cancer might affect all-cause (overall) survival.

This study was part of a much larger epidemiological investigation into racial differences in cancer outcomes among men and women with four types of cancer. As a consequence of the larger study design it is relevant that, of the 251 eligible participants, 115 were African-American and 136 were white. In addition, the distribution of prostate cancer stage at diagnosis was similar across the participants when categorized by race.

On the other hand, it is also important to acknowledge that, diagnosed as they were before the widespread use of the PSA test, most of these patients were probably diagnosed with more advanced disease and at an older age than the average patient being diagnosed today. It may, therefore, not be appropriate to apply the findings from this study “wholesale” to patients being diagnosed in more recent times.

The results of analysis of data from their study showed that:

  • Median follow-up of men in the study was 7.9 years.
  • 175/251 participants died during follow-up.
  • 68/251 participants did not believe that most cancers can be cured.
  • Among the 68 men who did not believe that most cancers can be cured (by comparison with those who did)
    • There was a statistically significant 62 percent increase in risk for overall mortality within the follow-up period (hazard ratio [HR] = 1.62).
    • There was a 37 percent increase in risk for prostate cancer-specific mortality within the  follow-up period (HR = 1.37), but this was not statistically significant.
  • What the study participants believed about the efficacy of checkups or potential “harms” of treatment was not associated with survival.

According to the authors, the results of this study appear to match those from similar studies about patient beliefs and long-term outcomes in patients with breast and colorectal cancers.

8 Responses

  1. Maybe it has nothing to do with our beliefs and cancer really is a long-term killer. If this study is suggesting that attitude plays a role then where is the army of long-term survivors who had a positive attitude? I don’t see them anywhere. Not on the forums, in the news or anyplace. All I hear are doctors quoting stats, and I don’t see any bodies to back them up.

  2. This result was told to me last month by an immunologist I met by chance. He said that science is coming to see a link from mood and attitude to immune system functioning, and then to various cancers. He stressed that if the connections exist, then the link might retard the division rate of cancer cells. He said that this does not prevent cancer. He also said that we do not yet know if the link exists and, if it exists, exactly how it works. As of now, results are highly suggestive and becoming more so.

  3. George: One of the authors of the paper above has already indicated to me that some of the issues you mention are a key part of their future research.

  4. Seems to me that possibly as educators and advocates for the men dealing with prostate cancer we need to encourage more participation in support groups and encouraging clinicians to evaluate men for depression or negative attitudes. Those of us involved with CCC programs can encourage survivorship programs to include prostate cancer programs that address attitudes about their ability to survive. We may need to increase the discussion of the success stories of men with prostate cancer. If I was planning future studies I would be interested to know more about what interventions for men help men to reduce anxiety, isolation or depression. Unfortunately most survivorship programs that I am aware of are more likely to attended by women.

  5. Sitemaster: Thanks. I am quite glad to hear that.

  6. Kathy: ” … attended by women”? Why is this so? I have no experience with groups. This article strongly suggests that groups can be useful for men, if properly conducted. Strange!

  7. George:

    I think we need to distinguish carefully between the traditional “support group” (relatively common in the prostate cancer community) and true cancer “survivorship” programs run by organizations like the Cancer Support Community (formerly the Wellness Community) and some community cancer centers (CCCs). The latter are much more structured in their nature and have (to date) been very much more targeted to women with breast, ovarian, and other types of cancer. Part of this reflects the very different ways that men and women look at life’s problems. Women tend to seek out and value “shared experience” with their “sisterhood;” men tend to grit their teeth and “tough things out.”

  8. Thanks Sitemaster. I didn’t know about this distinction. I live in Sweden, having moved here from Amsterdam, where things are quite differently arranged. The patients’ “groups” there are organisations that advise patients but are fully dependent on government subsidies to exist. As far as I know there are no support or survivorship groups in this system. This explains my ignorance. These clubs organise meetings for one day now and then, where members are lectured to, solely by Dutch specialists. It is very bad, IMHO. My lack of knowledge might be symptomatic of the dangerous structure of prostate cancer treatment there. I left when I was offered treatment options that I knew to be suboptimal, thanks to advice I got here in Sweden. It turned out that I was correct to do so, but that is another story.

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