Topic of Cancer

I’ve got you under my scan: CT scans and X-rays confirmed a tumor growing on the left side of my neck.

This past holiday season brought an unexpected return of a gift I received five years ago, a gift only nature in her caprice could bestow: The gift of cancer. Cancer isn’t a gift anyone wants of course; but once you have it, you either deal with it or you die. Or, in the case of many terminal cancers, you deal with it and you die.

When my cancer first appeared many years ago, I was reassured by statistics that my cancer was not only treatable but curable. I had surgery and subsequent radiation treatments. I had regular CT scans for five years, after which I was expected to be pronounced forever cured. In fact, I was days away from getting my final CT scan when I noticed a lump on my neck. It was not to be my “blessing year” after all.

This time I chose to take more people into my confidence. Several friends already knew of my previous experience, so it made sense to update them. And I had a new partner, who understandably needed to process the issue with his friends.

The reactions were interesting. I received messages of sympathy, of course. Support, sure. But some went beyond either offering some almost metaphysical advice. “Fighting is important,” wrote one acquaintance. “Fighting doesn’t just mean medically. It means emotionally. It means lifestyle-wise. It means altering everything you do to fight the cancer. Everything. This is total war. Everything you do is going to be focused on fighting it.” Nor was this an isolated case; others reacted in a similar vein.

I’d heard this rhetoric before, mainly on television dramas and from friends coming to terms with AIDS. Fight, fight, fight! Some people go beyond metaphor, advocating meditations in which you visualize the cancer as an enemy and your medicine or immune system as an army battling back the foe.

Me, I’m not convinced.

I’m aware, of course, of the research showing that a patient’s attitude has a clear effect on disease. For example, scientists think stress can have a deleterious effect not just on one’s emotions and sense of well being but also on the immune system and may even be an important factor in “coronary artery disease, high blood pressure, chest pains or even irregular heart beats” (WebMD.com, October 2005).

But evidence of a mind-body connection and the importance of attitude hardly validate the all-out war approach advocated by some. For starters, it seems rooted in the Western male psyche, with its obsession on power, control, and aggression. I’m not sure how stirring myself up to thoughts of battle is going to reduce the anxiety of my cancer experience. Wouldn’t a more Buddha-like acceptance of the inevitable be just as likely (if not more so) to bring inner peace and reduce unhealthy stress for many cancer patients?

No doubt the emphasis on fighting one’s disease is intended to be empowering for those who may feel particularly helpless in the face of such an awful illness. Unfortunately, this approach can also have the opposite effect. Believing that an individual can cure her or his own cancer or prolong his life lays a heavy burden of responsibility and even guilt on the patient who doesn’t see the cancer responding as hoped. Such guilt and shame can quickly turn into stress that further demoralizes the cancer patient.

This downside is not lost on Dr. Jimmie Holland, physician and psychiatrist who has counseled cancer patients for well over two decades at Memorial Sloan-Kettering Cancer Center in New York City. Holland is co-author (with Sheldon Lewis) of The Human Side of Cancer, Living with Hope, Coping with Uncertainty (HarperCollins, 2001). In a chapter titled “The Tyranny of Positive Thinking,” she dismisses as simplistic pop-psychology the notion that stress causes cancer. She also contends that “It is unrealistic that as you cope with nausea, fatigue, and worry and sadness, that you can be positive all the time. Yet, zealous believers in positive thinking may make you feel guilty when you find yourself crying sometimes.”

Moreover, science does not support the view of what Holland calls “positive attitude police.” “While stress does affect the immune system, there is no evidence that the blips produced are in the range of those that would affect tumor growth,” she writes. “We will know more in the future, but for now, the studies do not support the myths about psychological causes of cancer and the role of emotions in tumor growth.”

Since the publication of Holland’s book, other studies have made a similar point. In the November 2002 issue of the British Medical Journal, Mark Petticrew, PhD, and others reviewed 26 studies to see whether a particular psychological coping style had any effect on cancer. Some 11 of these studies specifically investigated the role of a “fighting spirit.” Their conclusion? “There is little consistent evidence that psychological coping styles play an important part in survival from or recurrence of cancer.”

Petticrew, a health researcher with the MRC Social and Public Health Sciences in Glasgow, Scotland, was of course not disparaging upbeat thinking. “We certainly aren't saying that a positive mental attitude is not beneficial,” he is quoted as saying to WebMD.com (November 2002). “I think the message here is that while it is good to think positively, it is also OK to feel bad. It is probably not going to influence your outcome.”

In my case, I feel no particular need for a “fighting spirit” or any other aggressive attitude. I am hopeful nonetheless. I’m lucky to have been struck with a cancer that has an impressive cure rate. Although the statistics aren’t quite as reassuring for those whose cancer has spread as far as mine, the five-year survival rate is still quite high.

Of course I would prefer not to have the cancer at all. I still may die from it. But any of us could die from so many causes any day. How sad it would be to get so caught up in fear and coping strategies that don’t fit our personalities that we end up killing our enjoyment of life before the end of life itself.