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by Ross, R.Ph. Pelton, Lee Overholser

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The Psychology of Cancer

WE ARE ONLY beginning to understand, in a scientific way, the connection between disease and the mind. There is a rapidly growing body of research studying the relationship among emotions, personality characteristics, and disease, especially cancer. The answers are beginning to emerge, and they demonstrate a definite connection between emotions and the chances of developing cancer, as well as the prognosis of the disease once it has appeared. This review of the literature will emphasize the most recent developments and discoveries.

Several psychological characteristics appear to influence the course of cancer: depression, stress, lacking a sense of control, having a negative outlook, and lacking an adequate support system. All correlate with a poor prognosis. Having a sense of control, a positive outlook, and a good support system correlate with a better prognosis.

Personality and Cancer

Chronic depression has been identified as an element in the development of cancer. An investigation of the relationship between depression and cancer called the Chicago Study followed two thousand workers at Western Electric for seventeen years. (28) The study found that those who had significant depres sion on the MMPI Depression Scale were 2.5 times more likely to develop cancer later in life.

Characteristics such as the ability to express anger and fight against cancer can influence the outcome of the disease. In 1975 Drs. Steven Greer and Tina Morris reported that women with malignant breast tumors had more difficulty in expressing anger than those with benign tumors. (13)

Greer also found that cancer patients who had a "fighting spirit" lived longer. (14) In this study high levels of anger correlated with better outcome, and patients who felt helpless or hopeless did poorly. These studies are showing us that a patient's will to live or fighting spirit has a great deal to do with chances for recovery.


Surprisingly, those who engaged in denial had a better chance of survival than those who felt hopeless. Denial included saying such things as "I didn't have cancer. The doctor only removed my breast as a precautionary measure." (15, 16)

A ten-year follow-up (26) confirmed the original findings. Of those who showed a fighting spirit or denied they had cancer, 55 percent were still alive, compared with 22 percent of those who had a helpless/hopeless response or engaged in stoic acceptance. But why would denial help? Apparently patients who deny they have cancer feel better and adjust better than those who give up and feel utterly hopeless.

It seems surprising that denial could be an effective coping mechanism for cancer. However, denial enables a person to concentrate on current and future goals. Having a purpose and goals seems to be correlated with improved immune function and a more hopeful prognosis.

Confirming the Results

Replication is important in gaining scientific acceptance. A study that gives the same results when other researchers repeat it is much more convincing than one that gives mixed results when others carry it out. In this case, several studies confirm that negative emotional reactions to cancer such as feeling helpless and hopeless lead to a poorer prognosis.

A study of attitudes in patients with malignant melanoma (10) showed that stoic acceptance in women and helplessness/hopelessness in men were associated with poorer outcome. A study of women with primary, operable breast cancer (8) found that denial was a significant predictor of a good outcome. Emotional expression, even expression of so-called negative emotions, may be good for one's health by buffering the possible negative effects of distress and depression.

A study that carefully reviewed the evidence related to emotional and psychosocial factors affecting cancer patients concluded that the "inability to express emotion, particularly in relation to anger" is a real factor contributing to the progress of a cancer. (23) Those patients who repressed their emotions had a greater likelihood that their cancer would grow and spread.

Attitude and Control

The attitudes people have when they discover that they have cancer range from determination to fight the disease to denial to utter hopelessness. A highly significant study published in 1979 showed that cancer patients who were rated as less cooperative by doctors and nurses lived longer. (9)

The researchers also discovered that more difficult patients received less radiotherapy before the study began. This could be the result of the patients taking more control over their treatment and their lives. Thus, they chose (or demanded) more appropriate levels of treatment. In general, those patients who are determined to conduct their own therapy are the most likely to get better. Interestingly, these are not seen as "good" patients by doctors.

Joy and a Positive Outlook

While negative emotions predict a poorer prognosis for cancer patients, positive feelings like joy go together with a better outcome. A seven-year follow-up of breast cancer patients by Sandra Levy, associate professor of psychiatry and medicine at the University of Pittsburgh and director of behavioral medicine in oncology at the Pittsburgh Cancer Institute, showed that those patients who expressed more joy in their lives when initially tested lived longer. (21) This result does not conflict with the studies that showed that an angry or fighting response to cancer predicts a better outcome. It is quite possible to have a sense of joy in life and a fighting spirit at the same time.

Optimism helps too. A study of women with cervical cell abnormalities (12) reported that the women with high scores for pessimism, hopelessness, and social alienation were more likely to progress to cancer of the cervix. On the other hand, optimism and active coping styles were connected with reduced risk of progress to cancer. (3)


Stress is one of those things that is easy to point out but very hard to measure. It's particularly difficult to define, since stressful influences vary from one individual to another. One person could find a demanding job extremely stressful, while another would enjoy the challenge. What is restful calm to one person may be unendurable boredom to another.

Stressful influences can be defined as those events or activities that exceed the individual's ability to cope comfortably. Stress is perhaps the ultimate subjective variable, and the best way to be sure an event is stressful is to ask the person himself.

Stress has a strong effect on the development and outcome of cancer. It has been shown that there is a correlation between stressful life events such as the death of a family member or the breakdown of important family relationships and relapse of breast cancer. (27)

Psychoneuroimmunology PNI

The study of the physical effect of the mind on the immune system is called psychoneuroimmunology. The most important cells in the immune system for fighting cancer are the natural killer (NK) cells. The NK cells appear to have little ability to inhibit the development of solid tumors (5) but are effective in preventing a cancer from spreading by killing the cancer cells as they migrate and before they begin to form new tumors. (17) The idea that NK cells patrol the body, eliminating cancer cells as they develop, is called the immune surveillance theory. One of the early proponents of immune surveillance and the man who coined the term psychoneuroimmunology, Dr. F. Macfarlane Burnet (6), pointed out that a weak immune system can make people more susceptible to cancer. The frequency of Kaposi's sarcoma among AIDS patients is an example of a cancer developing when the immune system is damaged.

More evidence comes from the spontaneous remission of established cancers. In a study of 130 clear cases of spontaneous remission of malignant tumors, the only explanation for these cases seems to be that the immune system learns to recognize the cancer cells and destroys them. (11)

The latest discoveries by Dr. Augusto Ochoa and his colleagues at the National Cancer Institute show that some cancer cells are able to protect themselves against immune surveillance. The researchers found that mice with colon cancer have sluggish NK cells. It appears that the cancer cells are actually producing a substance that turns off the NK cells. Researchers are also finding similar changes in human patients with colon cancer. (2) These discoveries indicate that those cancer cells that survive and become a threat are the ones that avoid detection by the immune system. The question is "Can the mind trigger the immune system to find and remove the cells that turn off the immune system?"

The Immune Connection

Several pathways showing that the brain and nervous system affect the immune system have been discovered. Most of the brain/immune-system connections relate to ways of coping with stress. With sudden stress the brain stimulates the adrenal gland to release adrenaline and other powerful stress response hormones that weaken the immune system. (7)

Under chronic stress the adrenal gland puts out another hormone, called cortisol, which suppresses the immune system, especially the NK cells that attack cancer. (24) When mice prone to developing breast cancer were repeatedly stressed with foot shocks, they had reduced NK cell activity and shortened survival time. (29, 30)

Cells communicate with one another through chemical messengers called peptides. Candace Pert, a leading researcher in the area of mind/body communication, has discovered many new neuropeptides that carry messages from the brain to the body. She concludes that the neuropeptides are the physical expression of the emotions. She no longer sees any need to distinguish between the brain and the body and refers to a single, integrated entity, the "bodymind." (25)

The immunologist Edward Blalock has found that the immune system sends messages back to the nervous system via peptides, completing the communication loop between the brain and the body. To him the immune system functions as a sensory organ that gathers information about the state of affairs in the body, which it relays to other immune cells and to the nervous system. (4) These studies indicate that what we think and feel has considerable influence on the functioning and effectiveness of the immune system.

Natural Killer Cells and Stress

The mind/body connection is amazingly powerful. An ever-increasing number of studies is showing that stress and depression suppress NK cell activity. In one study rats were given a powerful form of chemotherapy in a saccharine solution. At a later date, when the rats were given saccharine alone, they started dying off simply because their immune systems were conditioned to associate the sweet taste of harmless saccharine with the poisonous chemotherapy. (1)

Sandra Levy and others investigated the correlation between NK cell activity and mood. Levy found that healthy people who felt they were under stress had persistently low NK cell activity. (20) In a study of cancer patients she found that NK cell activity was not affected by chemotherapy or radiotherapy, but was correlated with three indicators of distress: patient adjustment, lack of social support, and symptoms of fatigue and depression. (22)

Depression and Natural Killer Cells

Michael Irwin has carried out several studies of links between NK cell activity and depression. His research team found that women whose husbands had recently died showed reduced NK cell activity. (18) He investigated the effect of disturbed sleep patterns in depressed patients and found a positive correlation between poor sleep patterns and reduced NK cell activity in both the depressed and control subjects. (19)

The studies examined so far clearly demonstrate that our emotions and moods can affect the immune system. We also know that a healthy immune system is essential to disease prevention. But does the state of the immune system extend to preventing and controlling cancer?

Can the Mind Cure Cancer?

Several studies we have examined show that there is a definite correlation between emotional stress and the development of disease, including cancer. Likewise, we can conclude that a positive outlook, lowered anxiety and depression, a sense of control, and improved mood increase the survival times of cancer patients. There is solid evidence that stress and mood negatively affect the status of the immune system.

The exact mechanism by which emotions and mood affect the development of cancer is not known. It is clear that the mind affects the beginning and outcome of cancer, but it is not yet clear how psychological factors produce those changes in our health.

Even though we may not know precisely how the mind influences the course of cancer, it is prudent to take steps to safeguard our mental health as well as our physical well-being.

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