Back_button_2

 

CANCER AND THE ROLE OF THE MIND

Don Benjamin


Alternative therapists claim that
the causation and control of cancer has not only physical but psychological and
spiritual factors as well. Orthodox medicine on the other hand accepts only the
physical factors. What is the evidence that theories relating to psychological
factors are valid and that therapy based on these theories actually works?


There are many factors which are claimed to
be involved with the causation and control of cancer.

These include

(a) physical factors such as:

  • diet and nutrition, including salt, artificial colouring,
    flavouring, food processing and preservatives
  • the environment, including water and airborne contaminants
  • occupational exposure such as asbestos and radiation

(b) psychological factors such as:

  • the mind, operating at both the conscious and unconscious level
  • personality
  • inherited predisposition

(c) spiritual factors such as

  • the psyche, soul or spiritual identity

Orthodox medicine accepts only physical
factors such as diet and occupational exposure, and then only as causative
factors. They have several theories about the process of cancer causation and
reject any claims that diet can have any effect on survival once malignancy is
established.

They refuse to look at any theories other
than the currently accepted one that the tumour is the disease. Surgery and
radiotherapy are designed to kill or otherwise remove the tumour. When this
fails and the “disease” has “spread” chemotherapy is then
used.

Not surprisingly there is no evidence that
surgery or radiotherapy has any effect on survival or mortality with any form
of cancer except where the tumour is obstructing a vital organ or pressing on
the brain1. The only evidence that orthodox methods can improve
survival significantly is in a few areas where cancer is known to be systemic
in its nature such as with some types of leukemia, and chemotherapy, a systemic
therapy is used. In view of the extremely toxic nature of chemotherapy and it
effect on the immune system it is not surprising that it is ineffective against
solid tumours2.

The more honest medical scientists are at
last starting to use the term “incurable” in relation to cancer3.
This means incurable using orthodox methods.

What about other theories and paradigms?

Most alternative therapies are based on the
theory that cancer is a systemic disease and tumours are only local
expressions, symptoms or elements in this disease. Such therapies are then
designed to restore the body’s metabolic functions, respiratory, digestive and
endocrine systems so that the immune defences can work normally again.

Some therapies assume the immune defences
have simply broken down because of psychological factors. For example the
Simonton Therapy4, which involves visualisation and imagery
techniques, assumes that stresses with which the individual cannot cope lead to
emotional disturbances in the limbic region of the brain. Here the hypothalamus
transfers these disturbances to the pituitary gland which in turn controls the
body’s endocrine system and thereby the body’s immune defences.

Other therapies assume a breakdown of
metabolic or endocrine systems which in turn lead to the “cancer
milieu”5.

What is the evidence that theories
relating to psychological factors are valid and that therapy based on these
theories actually works?

We can look at both the cancer causation
mechanism and the cancer control mechanism. Just as diet is claimed to
contribute to cancer causation, nutritional therapies have been claimed to
reverse cancer. So it is with psychological factors.

Cancer causation

Let us first look at cancer causation. And
this also provides some ideas for those who wish to prevent cancer.

Several workers such as Hans Selye6
and Lawrence Le Shan7 have identified personality factors that are
claimed to be present in most cancer patients. In recent times these have been
refined somewhat and some recent trials have described eight such
characteristic factors for cancer patients:

  1. Involvement – Vacillate between extreme intimacy and extreme
    aloofness
  2. Feelings – Avoid the expression of feelings
  3. Rationality – Claim to be controlled by reason rather than emotions
  4. Anxiety – Deny fears or anxiety related to present or coming
    problems
  5. Harmonizing – Avoid arguments and confrontation and are rarely
    aggressive
  6. Hopelessness – Feel pessimistic about life and expect the worst
  7. Helplessness – Feel out of control and need a lot of support but
    have never accepted help from others
  8. Self-sacrificing – Work for others’ benefits and ignore their own
    needs

Sometimes they can be grouped into inability
to become involved or express feelings, hiding behind rationality (1-5),
hopelessness/helplessness (6-7) and self-sacrifice (8). These are sometimes
described as starving themselves of their own spiritual and human needs which
humans have for giving and receiving love.

In 1980 Michael Wirshing et al8
from the Psychosomatic Clinic at Heidelberg University in Germany interviewed
56 women just prior to biopsy for breast cancer. Interviews lasted 30-50
minutes and were taped. Most subjects were from the lower social class. Using
these 8 factors the interviewers correctly predicted 83% of the women who were
later diagnosed with cancer and 71% of those who had benign lumps. Others not
involved in the interviews listened to the tapes and made separate assessments.
These ‘blind’ raters predicted 94% of the cancer diagnoses and 68% of the
benign diagnoses.

So there is clearly a cancer personality or
profile. It is not black and white: for example between a quarter and a third
of patients diagnosed with benign lumps exhibited the psychological profile of
the cancer patient.

The next question to ask is:

Once people get cancer what personality
types have the best survival?

Two trials provide some answers:

  1. Sandra Levy et al9 from the
    Pittsburgh Cancer Institute looked at survival figures for 36 women who
    had their first recurrence of breast cancer. They found that those with a
    positive mental attitude best described as “joy” had the longest
    survival. This included descriptions of glad, cheerful and joyous
    attitudes. On the other hand negative attitudes, where patients felt sad,
    hopeless, worthless, miserable or unhappy tended to have the shortest
    survival, typically surviving less than 2 years after recurrence. The same
    applied to those exhibiting hostility. Their report was in 1988.
  2. Keith Pettingale et al10 from King’s College on London
    reported in 1979 that psychological responses to cancer diagnosis taken
    from 57 women with early breast cancer 3 months after their operation
    predicted survival 5 years later.

Best survivals were found among those with a
“fighting spirit” and those who practised “denial”; whereas
worst survival was observed among those with “stoic acceptance” and a
feeling of “helplessness” or a situation of “hopelessness”.
They reported again 5 years later, 10 years after original diagnosis. 70% of
those with a “fighting spirit” were still alive including one with
metastases as were 50% of those exhibiting “denial”, 25% of “stoic
accepters”, including one with metastases, and 20% of those who felt
“hopeless/helpless”.

There were no initial biological differences
observed, all four patient groups having similar clinical stage, approximate
tumour mass, histological grade, mammographic appearance and hormonal an
immunological profiles. The difference in host resistance was apparently
related to psychological factors.

The next question to ask is, if the
personality type predisposes certain people to get cancer and certain other personal
attitudes appear to affect survival, can one’s personality type and attitude be
changed to enable a building up of this host resistance?

For example can a person learn how to
express feelings? Can he or she learn how to put their interests ahead of those
of other people? Can a person change from feeling helpless to one with a strong
fighting spirit? My answer to these questions is Yes!

What evidence is there that psychotherapy
can improve survival or reduce mortality?

There are three trials offering some
evidence that psychotherapeutic intervention can affect survival:

  1. Fawzy I. Fawzy et al11 from the Neuropsychiatric
    Institute at the UCLA School of Medicine analysed immunological responses
    in 61 cancer patients with malignant melanoma over six months. There were
    28 men and 33 women randomised into two groups, a study group of 35 and a
    control group of 26. The study group was given a structured psychiatric
    group intervention which lasted about 1-1/2 hours per week for 6 weeks.
  2. Although not many changes were observable after six weeks there
    were significant differences observed between the two groups after six
    months. The study group which had received psychotherapy showed:
  3. a reduction in the level of psychological distress
  4. a greater use of active coping skills
  5. a significant increase in the percentage of larger granular
    lymphocytes (LGLs)
  6. a significant increase in the percentage of natural killer cells
    (NKs)
  7. an increase in NK cytotoxic activity

So the psychotherapy not only made the
patients feel they were coping better with the disease; their immunological
responses confirmed that they were. These results were reported in 1990.

2. David Spiegel et al12 from
Stanford and Berkeley Universities in California reported on the effect of
psychosocial intervention on survival with a group of 86 patients with
metastatic breast cancer. These patients were randomised into two groups, a
study group of 50 and a control group of 36. Both groups had routine
oncological care, but the study group was offered weekly supportive group
therapy and self-hypnosis for pain for 1 year.

The survival figures showed a divergence
beginning 8 months after the psychosocial intervention ended, ie after 20
months. Average survival for the study group was 36.6 months compared with 18.9
months for the control group. The effect of the intervention was also to reduce
anxiety, depression and pain.

The researchers were initially sceptical of
claims that visualisation and imagery could improve survival so they did not
use this technique. Rather they emphasised living as fully as possible,
improving communications with family members and doctors, facing and mastering
fears about death and dying, and controlling pain and other symptoms. An
important factor observed was that the study group formed a bonding that
countered the social alienation that often divides cancer patients from their
well-meaning but anxious family and friends.

An unusual phenomenon observed was that the
increased survival did not become apparent until nearly a year after therapy
had finished. The authors attributed this to a mild cumulative effect.

The authors were not able to explain the
results but speculated that neuro-endocrine and immune systems may be a major
link between emotional processes and the course of cancer.

Two possible shortcomings of this trial were
not knowing how representative the patients were of the wider community; and
the limitation of matching in small groups by relying only on randomisation.
Neither of these would have affected the validity of the result because the
effect was so large.

A third study demonstrating the efficacy of
group or behavioural therapy in the treatment of cancer is one by Hans J
Eysenck and R Grossarth-Maticek from the University of London13.

In the Eysenck and Grossarth-Maticek paper,
published two years after Spiegel’s, there was improved randomisation. Patients
suffering stress were first matched into pairs based on sex, age, smoking,
cholesterol level, blood pressure and personality type. Only after both members
of a matched pair had agreed to participate in the trial were they randomised
into therapy and control groups. This guaranteed that the therapy and control
groups were accurately matched despite their small sizes. Cancer prone (Type 1
or “Type C”) and coronary heart disease (CHD) prone (Type 2 or
“Type A”) patients were treated separately in some of the studies.

They carried out six studies to test various
hypotheses:

  • the effect on the prevention of cancer and coronary heart disease
    of
  • individual therapy
  • group therapy
  • bibliotherapy (learning the therapy from a text);
  • effect of behaviour therapy on preventing absence through illness
    requiring hospitalisation;
  • the effect of behaviour therapy on survival of terminal cancer
    patients; and
  • a comparison of the effects of behaviour therapy and chemotherapy
    on the survival of cancer patients.

Results were as follows:

Study 1 – Extended Individual Therapy

Patients were aged 30-69, mean age 50yrs;
half were men and half were women; matching of pairs prior to randomisation was
on the basis of age, sex, degree of stress, intensity of cigarette smoking,
blood pressure, blood sugar level and cholesterol. Six to twelve months after
completing therapy their personality types were reassessed using the same
questionnaire as before to measure any short-term changes to the personality
that might explain the effects of treatment.

Results: After 13 years of follow-up, none of the 50 treated in the cancer
prone group had died compared with 16 of the 50 in the control group. 13 had
cancer compared with 21 in the control group, 5 had died of other causes (cf
15) and 90% were still alive compare with 38% in the control group.

Personality retyping showed the therapy
group’s cancer proneness scores had fallen from 9.8 to 5.7. As expected there
was no change in score (9.8) for the untreated control group.

Study 2 – Group Therapy

This was similar to Study 1 except that 245
patients received therapy in groups of 20-25 people; the untreated control
group also contained 245 people; sessions lasted several hours depending on the
wishes and progress of the participants; there were 6-15 sessions altogether.

Results: After 7 years follow-up there were 18 cancer deaths in the 239 treated
group compared with 111 of the 234 in the control group (A few could not be
contacted). 75 were alive with cancer compared with 129 in the control group.;
10 had died of CHD compared with 36 in the control group, CHD incidence was 29
(cf 45); 20 had died of other causes (cf 33) and 80% were still alive compare
with 24% in the control group.

Study 3 – Bibliotherapy (therapy
described in an article and explained in 3-5 hours of discussion)

There were 600 in the study group and 600 in
the control group. (The latter were given an article that did not include any
treatment techniques for them to use.)

Results: After 13 years follow-up there were 27 cancer deaths in the 600
treated group compared with 106 deaths in the 600 in the control group; 99 were
alive with cancer compared with 162 in the control group; 47 had died of CHD
compared with 145 in the control group, CHD incidence was 132 (cf 203); 115 had
died of other causes (cf 164) and 68.4% of those treated were still alive
compare with 16.3% in the control group.

Study 4 – Illness, Absence,
hospitalisation

362 pairs of males suffering stress were
randomised in the usual way after matching and one group was treated. During
the following 13 years the number of days spent in hospital was measured for
the two groups.

A total of 6194 days were spent in hospital
by the treated group averaging 19 days each.

This compares with 10,136 days in hospital
by the control group, averaging 28 days each.

Study 5 – Therapy on Terminal Cancer
Patients.

This study involved 24 pairs of cancer
patients with six different types of inoperable cancer, including scrotal (1),
stomach (2), bronchiolar (7), corpus uteri (4), cervical (5) and colorectal
(5).

Survival times of the treated group averaged
5.07 years (ranging from 1.7 yrs for bronchiolar to 9.5 yrs for colorectal).
For the control group survival averaged 3.09 years (ranging from 1.0 yrs for
bronchiolar to 4.9 yrs for colorectal)

Study 6 – Behaviour therapy vs
Chemotherapy

129 women metastasised breast cancer for
whom chemotherapy had been proposed were asked to participate. 17 refused
psychotherapy and 56 refused chemotherapy. 50 of those who accepted
chemotherapy were divided into pairs matched for age, social background, extent
of cancer and medical treatment. One of each pair was then randomised to
receive psychotherapy. Similarly 50 of those who refused chemotherapy were
matched then one of each pair was randomised to receive psychotherapy.

This study therefore involved 100 women with
metastasised breast cancer, in four similar groups of 25 who received
chemotherapy + psychotherapy, chemotherapy alone, psychotherapy alone and no
therapy. Of the 50 who received psychotherapy 24 received creative novation
behaviour therapy (as in studies 1 and 2), 12 received depth psychotherapy and
14 received orthodox behaviour therapy (relaxation training and
desensitisation). 30 hrs of psychotherapy was given.

Results: Mean survival times for the 100 patients was 15.7 months, ranging from
11.28 for those who received no therapy (having refused chemotherapy), to 14.08
for chemotherapy alone, to 14.9 for psychotherapy alone to 22.4 months for
chemotherapy + psychotherapy.

The authors state that chemotherapy alone
increased mean survival by 2.80 (14.08-11.28) and psychotherapy alone increased
it by 3.64 (14.9-11.28). Theoretically by adding these two effects chemotherapy
+ psychotherapy should have increased survival by only 6.44 months to 17.72
months. In fact it increased it to 22.4 months exceeding the additive value by
4.68 months, suggesting a synergistic interaction between these two therapies.

It was also observed that the lymphocyte
count of those receiving psychotherapy continued to rise over time whereas
those not receiving psychotherapy fell, suggesting that the psychotherapeutic
intervention may have had its effect through the involvement of the immune
system.

The authors recognise that the trial was not
one to test the effect of chemotherapy versus no chemotherapy, so there was no
need to randomise patients into “chemotherapy” and “no
chemotherapy” groups. This was done by self-selection: those
refusing chemotherapy became the source for selecting and matching 50 women who
would receive no chemotherapy but would be randomised to receive or not receive
psychotherapy. This is in contrast to psychotherapy where in each case there
was proper randomisation into the treatment and no treatment groups.

Comment:

The process of self-selection introduces an
unknown factor into the trial. Earlier trials of mammogram screening have shown
that those who refuse various therapies have such different personality
profiles from those who accept them that that their mortality rates are quite
different. This means that while comparison of survivals between psychotherapy
and no psychotherapy groups remain valid, similar comparison between
chemotherapy and no chemotherapy are less reliable statistically.

In all of the above evidence the number of
participants in the trials has been small. However, providing:

  • the results are based on comparing two groups that have been
    randomised;
  • the groups after randomisation are found to be very similar in
    their makeup in relation to the age and socioeconomic level of patients
    and the stage of disease;
  • the difference in survival or mortality between the study and
    control groups is quite large; and
  • the only factor varied was the addition of the particular therapy;

the results of such comparative trials are
quite valid.

SUMMARY

It is therefore clear from the available
evidence that:

  • psychological factors play an important part in determining
    1. a person’s susceptibility to getting cancer;
    2. survival once cancer has been diagnosed with
      cancer.
  • therapies based on changing these psychological factors can have a
    significant impact on the course of the disease.

It is therefore important that all cancer
control programs incorporate some form of psychotherapy as an integral part.

REFERENCES

  1. Benjamin, D. Efficacy of surgical treatment of cancer. Medical
    Hypotheses 1993; 40:129-138,.
  2. Langlands, A. Battling breast cancer with dollars and sense, MJA 18
    July 1994:161.
  3. Ulrich Abel Abel, U. Chemotherapy of advanced epithelial cancer: a
    critical review. Biomedicine & Pharmacotherapy 1992; 46: 439-452.
  4. Simonton, S. & C. Getting Well Again, Bantam, New York 1978.
  5. Issels, J. Cancer A Second Opinion, Hodder & Stoughton, London
    1975.
  6. Selye, H. The Stress of Life, McGraw-Hill, New York, 1956.
  7. Le Shan, L. Psychological states as factors in the development of
    malignant disease: a critical review, J. Nat. Cancer Inst 1959; 22:
    1-18.
  8. Wirshing, M. et al. Psychological identification of breast cancer
    patients before biopsy. J. of Psychosomatic Research 1982; 26:
    1-10.
  9. Levy, S. et al. Survival hazards analysis in first recurrent breast
    cancer patients: Seven-year follow-up, Psychosomatic Medicine 1988; 50:
    520-528.
  10. Pettingale, K. et al. Mental attitudes to cancer: an additional
    prognostic factor. The Lancet, March 30, 1985.
  11. Fawzy, Fawzy I. et al. A structured psychiatric intervention for
    cancer patients. Arch Gen Psychiatry August 1990; 47: 729-735.
  12. Spiegel, D. et al. Effect of psychosocial treatment on survival of
    patients with metastatic breast cancer, The Lancet, October 14, 1989.
  13. Eysenck, H and Gross-Maticek, R. Behaviour Research and Therapy
    1991; 29(1): 17-31.

-oOo-

Back_button_2