Hope – The Fine Line Between Help and Hurt

By Rachael Myers Lowe, cancerpage.com

Hope sustains and stimulates, comforts and cheers, encourages and inspires us– Zarathushtra

(February 9, 2004) - There is no evidence that an optimistic attitude prolongs survival for cancer patients. In fact, trying to foster optimism in patients what don’t come by it naturally may do more harm than good. That’s not to say cancer patients who are more positive about their situation don’t benefit.  Optimism is associated with less depression and a higher quality of life. But the authors of a new report published in the March 15 edition of the journal Cancer conclude false optimism can hinder informed decision making by patients and their families and rob them of the best use of time they have left together.

Numerous studies over the years have tried to establish what impact attitude has on cancer patient survival. The results have been mixed with most showing no impact. That fact has not hampered the popular belief that a patient’s response to cancer, particularly optimism and having a “positive attitude”, influences survival. After all, “hope springs eternal in the human breast,” Alexander Pope wrote. 

And it seems to reason. There are several plausible mechanisms that would support such a contention.  A good attitude can strengthen your immune system and a stronger immune system may be better able to fight cancer, fight infection, and improve survival.  A positive attitude may lead a patient to eat better, stop smoking, exercise, and moderate alcohol consumption. Optimism might also lead a patient to gather more information about their disease and treatment options, which in turn could lead to better treatment decisions.

Penelope Schofield, PhD., of the Peter MacCallum Cancer Centre in Melbourne, Australia, and colleagues from cancer centers throughout Australia, designed a study to measure the affect of optimism on survival for non-small cell lung cancer patients. They enrolled 204 patients assigned to three treatment protocols for their disease. Patients filled out a questionnaire before starting treatment and again six weeks after completing the first round of treatments. The questionnaires were designed to measure levels of optimism and pessimism.

Non-small cell lung cancer is a very difficult disease to fight. Even with best-practice treatment, fewer than 15% of patients survive five years after diagnosis.  But the length of time of survival, within that timeframe, can vary significantly even among patients with similar characteristics, and disease states who receive similar treatment regimens.

The researchers write that while optimism went down slightly after treatment began, “optimism in patients did not appear to influence the length of overall or progression-free survival in this study. Indeed, there was not even evidence of a trend in this direction.”

Given the findings, Schofield suggests it may be time to question the value of encouraging unfounded optimism especially if it leads patients to conceal feelings of distress. Cancer patients often feel social pressure to think positively about their disease. They may, as a result, feel guilty if their disease progresses because they, obviously, weren’t positive enough.

Doctors and nurses have to walk a fine line.

Patients want their healthcare providers to be hopeful in the discussion about their chances of recovery. However, the authors write, hope is too often associated with unrealistic expectations. Yet, it’s not unreasonable to hope for a cure, even if a cure is unlikely.

Schofield concludes messages of hope should include more probable events related to quality of life issues such as long periods of remission and a patient’s ability to be free of pain.  To do otherwise, Schofield says, can be a source of regret “because it may hinder patients and family from making sensible treatment decisions and lifestyle decisions to make the best use of the remaining time together.“

SOURCE:

• Cancer  March, 2004.