How psychological therapy may prolong survival in cancer patients: new evidence and a simple theory.
This article presents new data and attempts to draw together converging lines of evidence on the mental attributes that may favor prolonged survival in the face of metastatic cancer. The authors interviewed 10 individuals with medically incurable cancers who had outlived their prognoses by from 2.2 to 12.5 years (and have all survived, a further 2 more years in most cases, between interview and publication). The authors derived, by qualitative analysis, a number of themes common to most or all of them. Three major qualities emerged: "authenticity," or a clear understanding of what was important in one's life; "autonomy," the perceived freedom to shape life around what was valued; and "acceptance," a perceived change in mental state to enhanced self-esteem, greater tolerance for and emotional closeness to others, and an affective experience described as more peaceful and joyous. Previous descriptions of "remarkable survivors" have suffered from a serious limitation: the research to date has not clarified to what extent they differed psychologically from their many peers who did not survive. The authors attempted to address this question in 2 ways. Six of the subjects were part of a protocol (the Healing Journey study) in which patients belonged to a larger group, all of whom were medically assessed prospectively, by an expert panel. A prediction of the likely duration of survival was made for each of the patients in this study, and it could be shown that those who subsequently survived were not a random sample of the whole but displayed a much higher degree of early involvement in their psychological self-help than did most of their nonsurviving peers. They also compared long survivors with 2 other groups: 6 individuals with similar diseases who had not yet received psychological help and 6 individuals from the Healing Journey study whose survival duration was at the lower end of the whole group. The patients in these comparison groups also lacked many of the most salient qualities identified among the long survivors. Many of the attributes found in the long survivors were, however, also noted in the earlier reports of remarkable survivors in the literature, which suggests that the observations may be generalizable. Putting these joint findings together with the early work of Temoshok on "type C" adaptation as a risk factor for cancer, one can see that there is a mirrored symmetry between the psychological patterns possibly promoting disease and the changed adaptations that may lead to longer survival in some cases. The authors arrive at a commonsense hypothesis: to the extent that the progression of cancer, or other chronic disease, is favored by a distorted psychological adaptation such as type C, healing may be assisted by a reversal of that adaptation--in the case of cancer, toward greater authenticity of thought and action.
Ontario Cancer Institute, Toronto, Ontario, Canada. acunningham@uhnres.utoronto.ca
Alastair J
AJ
Cunningham
Kimberly
K
Watson
D000223:Adaptation, Psychological; D000368:Aged; D001294:Attitude to Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D026684:Personal Autonomy; D011379:Prognosis; D011613:Psychotherapy; D011788:Quality of Life; D012657:Self-Help Groups; D016019:Survival Analysis; D017741:Survivors / Q000523:psychology*