The idea that stress increases the risk of breast cancer is a persistent one, despite a number of major large-scale findings to the contrary. “Over the past 40 years, women have been exposed to strong messages about the importance of ‘thinking positively’ and reducing stress in their lives, which can add to the burden of guilt in those who develop cancer, who feel they have somehow failed”, note the authors of a new prospective study of women in Australia, published in Psycho-Oncology. Their findings suggest that neither acute nor chronic stressors recorded over a three-year period influenced the likelihood that a woman with a strong family history of breast cancer would develop the disease over the next three years.
“Our results, based on rigorous methodology, add to the growing literature providing reassurance to women at increased risk of breast cancer, who are concerned that the (often unavoidable) stressors in their lives may increase their risk of breast cancer”, the researchers said.
It’s hard to imagine a crueller fate than when a child receives a diagnosis of an illness as difficult as cancer. A young human being, still not fully formed, is suddenly and irrevocably thrown into a situation that many adults are unable to cope with. Each year, around 160,000 children and youngsters worldwide are diagnosed with cancer, and this trend is growing in industrialised societies. Faced with such facts, it is particularly important to understand how children cope. What traces of the experience remain in their psyche if they manage to survive?
Partial answers to these questions come from a trio of Australian researchers in their systematic review and meta-analysis of existing research into the psychological effects of cancer on children, published recently in Psycho-Oncology. Their findings give us reason for some optimism. It turns out children and adolescents affected by cancer are no more likely to develop post-traumatic stress symptoms than their healthy peers. In fact, several studies have found that children affected by cancer go on to experience greater than usual adjustment and quality of life and lower anxiety and post-traumatic stress symptoms. In psychology, we refer to this as the post-traumatic growth (PTG) effect, which can arise from the struggle with highly challenging life circumstances or trauma.
After chemotherapy treatment, many patients say their mind has been affected. For example they describe symptoms such as feeling confused, memory problems and difficulty concentrating – a phenomenon that has been dubbed “chemobrain” (Cancer Research UK has more information).
The causes are little understood. Are these apparent neuropsychological effects due to a direct physical effect of chemotherapy on the brain? Or could it be the stress and worry involved in chemotherapy that is responsible? Perhaps it’s both. To find out more, Mi Sook Jung at Chungnam National University in South Korea, and colleagues, conducted repeated brain scans and neuropsych tests with breast cancer patients undergoing chemo and compared them with similar cancer patients not on chemo and healthy controls. Reporting their results in Brain Imaging and Behaviour, the researchers hope a better understanding of the nature of “chemobrain” and its causes will make it possible for health professionals to offer patients better support and care.
At least one in four readers of this post will die of cancer. This is a simple statistic that leads rationally thinking people to treat the possibility as very likely. And this is what many do: they try to adopt a lifestyle that minimises the risk to some degree. But how do we know what minimises and what increases this risk? Of course, by listening to experts, the best of whom are scientists who research these things. However, whenever there is disquiet brought about by uncertainty, self-titled experts come out of the woodwork. Discussion of factors increasing the risk of cancer is today not only the domain of medical doctors and psycho-oncologists, but is also engaged in by some alternative medicine proponents, pseudopsychologists, and fringe psychotherapists, whose opinions are disseminated by journalists, some more thorough than others (see myth #26 in 50 Great Myths of Popular Psychology for more background).
Among these opinions is the common claim that negative thinking, pessimism, and stress create the conditions for the cells in our body to run amok, and for cancer to develop. Similar declarations accompany therapeutic propositions for changing our way of thinking into a more positive one that will protect us from cancer, or even cure us of the disease. Should you, therefore, begin to fear the possibility of cancer if you are not prone to optimism, or – even worse – have bouts of depression?
When the dreadful news arrives that a child has cancer, understandably the focus of parents and health professionals turns to supporting the sick child as best they can. But also caught up in the nightmare are the child’s siblings. Not only will they likely be consumed by shock and fear, but they must adapt to the cancer journey the whole family has to embark on.
Official health guidance here in the UK and in the USA states that it’s important to provide support to the siblings of children with cancer. Yet the reality is we know relatively little about their experience. A new study in Clinical Child Psychology and Psychiatry helps address this research gap, based on interviews with two brothers and four sisters – now aged 12 to 18 – of children and teenagers with cancer. The results reveal the shock and fear the siblings experienced, and the challenges they’ve faced, but also uncover a silver lining in the form of “post traumatic growth”. Continue reading “What’s it like to be a child and your sibling is diagnosed with cancer?”→
One woman said she was proud of her
scars – the “war wounds of life”.
In the UK, nearly 10,000 young women are diagnosed with breast cancer every year and the treatment for many is mastectomy – the surgical removal of one or more of their breasts. It’s easy to assume that the effect on their body image will be negative, and UK guidelines currently state that all mastectomy patients should be told about options for reconstructive surgery. However, a key message to emerge from a new survey of young women who have undergone mastectomy is that there is huge variability in how they are affected, and that any support therefore needs to be individualised.
Sarah Grogan and Jayne Mechan (the latter has a diagnosis of breast cancer) conducted an online survey of 49 women recruited via an online support network, all of whom had undergone unilateral or bilateral mastectomy before the age of 45. Analysing their answers, the researchers identified four main themes.
The first concerned the way the women spoke of how they’d initially downplayed worries of aesthetics because their priority was survival. They also distanced themselves from the affected parts of their breasts and objectified them: “The thing for me was just to remove the offending article”, “I just had a gut feeling that I wanted the whole thing taken …”.
Post-mastectomy, body confidence became an issue, but some coped better than others. “I have lost all self-confidence in my naked body,” said one woman. “Body image has never worried me. I am who I am and I don’t go out to impress people,” said another.
The third theme was “changed identity”. Some women described compensating for their changed appearance: “wearing skirts, more make-up”, said one. “I want my body to look and feel strong so am doing quite a lot of weight lifting to try and remove the feeling that my body was weak and failed me,” said another. Others described the difficulties of adjustment: “I feel like I don’t recognise myself anymore. I used to wear low cut tops and now I cover up.”
The final theme on the effects of cancer treatment, including scars, weight gain and early menopause also revealed a variety of experiences among the women. Some took a positive view: “My scars are my war wounds of life. … I’m proud of them”. Others described how they were more bothered by the overall changes to their appearance: “Do not feel great about body image at all. Have gained weight due to early menopause, think that bothers me more than my breasts”.
The researchers said their results suggested women undergoing mastectomy may benefit from interventions that include body acceptance techniques and advice on media literacy, to help them critique cultural pressure to be slender. Above all they said they were struck by the “variability of experience of women experiencing a relatively similar event.” They said this insight has implications for health professionals – “it is important [they] do not expect homogenous patterns of negative responses in women who have had mastectomies so that they are able to provide tailored support if and when needed.”
Grogan, S., & Mechan, J. (2016). Body image after mastectomy: A thematic analysis of younger womens written accounts Journal of Health Psychology DOI: 10.1177/1359105316630137
The idea that prolonged stress is bad for your health is uncontroversial. And few things can be more stressful than receiving a cancer diagnosis and undergoing treatment. It makes sense, then, to consider that psychological interventions, aimed at providing cancer patients with emotional support and guidance on coping, might be beneficial. However, this is a delicate, controversial topic.
Not only is the evidence for the benefits of psychosocial interventions extremely mixed, but some cancer patients and their relatives have understandably railed against the “cruel” suggestion that they might live longer if only they looked on the bright side and didn’t get so stressed.
It’s against this background that researchers in South Korea have conducted a new review of the effects of psychological interventions on cancer patients’ survival time. Their study published in Psychology and Health is a meta-analysis which means that they have combined the results from prior research to get an overview of the current evidence base.
The researchers, led by P.J. Oh at Sahmyook University, found over 4,000 studies that looked promising, published between 1966 and 2014. However, once the researchers included only those papers that were randomised controlled trials and that included interventions delivered by professionals and had data on patient survival times, they were left with just 15 suitable studies conducted in five different countries and involving a total of 2940 participants with an average age of 52 years. The studies involved different types of intervention including psychoeducational programmes, CBT and supportive-expressive groups (a form of psychodynamic psychotherapy). The patients in the studies had a range of different cancers at different stages, including breast cancer, gastrointestinal cancer and melanoma.
Looking at all the data from all 15 studies, there was no evidence that psychosocial interventions prolong the lives of cancer patients. However, because of the huge variation between the studies in terms of the interventions and the types of patient, the researchers also broke down the evidence into sub-categories and here the picture was more promising. For example, by excluding six studies that had exclusively involved patients with late-stage cancer, the researchers found that psychosocial interventions reduced the likelihood of patients dying during the course of the study (follow up times varied from one to 12 years) by 27 per cent, on average. “Stress reduction, if that is the causal mechanism, may have to occur earlier to achieve positive results,” the researchers said.
Other details to emerge included the finding that a positive benefit of psychosocial interventions was only apparent for studies involving patients with gastrointestinal cancer, although there was too little data to speculate as to whether this finding is meaningful or a chance result. Comparing the different types of intervention, the strongest positive evidence was for one-on-one programmes compared with groups, and for psychoeducational approaches delivered by medical doctors and nurses, as opposed to psychologists or other non-medical professionals.
Psychoeducational interventions involve health education, coping skills training, stress management and psychological support, and the researchers speculated their benefit might arise through a mixture of reducing patients’ distress, encouraging healthy behaviours and treatment compliance. “In addition, supportive social relationships might buffer the effects of cancer-related stress on immunity and thereby facilitate the recovery of immune mechanisms and may be important for cancer resistance,” they said.
Critics may question whether it is reasonable to combine results from such varied studies as was done in the current meta-analysis, and the researchers acknowledged that many of the studies were not as robust in their methodology as they should be. However, they end their review on a positive note: “a tentative conclusion can be reached,” they said, “that psychosocial interventions offered at early stage may provide enduring late benefits and possibly longer survival.”
_________________________________ Oh, P., Shin, S., Ahn, H., & Kim, H. (2016). Meta-analysis of psychosocial interventions on survival time in patients with cancer Psychology & Health, 31 (4), 396-419 DOI: 10.1080/08870446.2015.1111370
The Kill or Cure website monitors the Daily Mail‘s attempt to “classify every inanimate object into those that cause cancer and those that prevent it”. Like many other media outlets, the Mail is drawn to health news that is contradictory and/or surprising and a perusal of the Kill or Cure website shows that the paper has frequently reported that the same items, such as aspirin or beer, both cause and prevent cancer.
Now a study published recently in Science Communication examines the impact of such stories and finds that they have a negative influence, provoking readers to distrust the stories themselves and also, more worryingly, their ultimate source – science.
Chingching Chang at National Chengchi University in Taiwan asked 200 students to read real health news stories that were either low or high in novelty (e.g. about how “green tea reduces bad cholesterol” or that “popcorn slows down ageing”); or one-sided (e.g. milk prevents cancer) or contradictory (e.g. milk both causes and prevents cancer).
Students who read novel or contradictory findings rated the news itself as less credible, had lower intentions to act on it, felt more uncertain, and reported more negative attitudes towards scientific health research in general, as compared with the students who read about unsurprising or one-sided health findings. Chang says this fits what we know about “motivated reasoning” – people don’t like feeling uncertain and so they will often respond to unsettling or confusing new information by doubting its credibility.
This general pattern of results was similar when Chang conducted a telephone survey of hundreds of members of the public, asking them to respond to health story headlines that were novel versus unsurprising, or one-sided versus contradictory.
On a positive note, the students who were exposed to either novel or contradictory stories still expressed levels of credulity and attitudes towards health research that were relatively positive on the rating scales that were used (albeit that they were notably more negative than the ratings given by the students exposed to low-novelty and one-sided stories).
Health journalists’ bias for surprising and contradictory findings (perpetuated in part by the work of university press offices), is to some extent understandable – it helps add drama and increases reader interest. But unless the novel/contradictory findings are placed in context and include appropriate caveats, Chang warned her findings suggest such stories can “leave people uncertain about scientific health research, and breed negative attitudes toward science and research overall.” Chang also advises news outlets to avoid “false balance”, in which “conflicting evidence with less support appears alongside evidence with overwhelming support.”
_________________________________ Chang, C. (2015). Motivated Processing: How People Perceive News Covering Novel or Contradictory Health Research Findings Science Communication DOI: 10.1177/1075547015597914
Early diagnosis of cancer can save lives, yet so many people wait before reporting important symptoms. This is an issue where psychology can make a major contribution by helping to explain why some patients delay reporting their symptoms to a clinician. A pilot study published recently in Psychology and Health uses an unusual approach for this purpose, specifically in the context of skin cancer, by asking patients to draw their melanomas.
Suzanne Scott at Kings College, London and her colleagues recruited 63 skin cancer patients (average age 64), around half of whom had a thinner melanoma, and half a thicker melanoma (prognosis is poorer for the latter group). Four of the patients had had their melanomas spotted opportunistically by a clinician; the others had waited between 1 week and 303 weeks before reporting their first symptoms to a clinician.
All the patients were asked to produce annotated drawings of their melanoma as it looked when they first noticed it, and how it changed over time. Fifty-three of the patients agreed to do this (three had their wife or daughter produce the drawings), while four patients were unwilling or unable to do the drawing. Overall, this suggests that the idea of drawing their symptoms is acceptable and practical for most patients. Some patients drew one picture, others did several. Men tended to produce more drawings than women. In all, 137 drawings were produced by 53 patients.
Image: participant drawing from Scott et al, 2015.
The researchers said the level of detail produced in the drawings shows that most patients tend to pay attention to their skin changes rather than dismissing them, but that they often don’t act on the changes. This is an important insight because it implies that public health interventions need to do more to educate people about the meaning of their skin changes and when it is appropriate to seek help.
Another key finding was that patients’ drawings correlated in size with their actual melanomas (as measured in histology photos), and yet there was no correlation between size of drawings and the time taken to seek medical help. The researchers said this further suggests that it is likely patients’ interpretations of the meaning of their symptoms, rather than their perception of the physical nature of the symptoms per se, that explains their decisions as to whether or not to seek help. It’s also notable that patients often depicted changes in size and colour in their drawings (two key features that are important for melanoma diagnosis), but other important diagnostic factors including shape and border irregularity were rarely depicted.
The study is limited by the small sample size and the reliance on asking patients to remember how they perceived their melanomas in the past. Nevertheless, Scott and her team said these preliminary results are encouraging and they suggest patient drawings could be a useful adjunct to standard interviews, furthering our understanding of how to achieve more early diagnoses. “Patient drawings add a deeper understanding of patient perception of their lesion,” they said, “… [drawings] can facilitate discussion of symptoms perception and appraisal.”
_________________________________ Scott, S., Birt, L., Cavers, D., Shah, N., Campbell, C., & Walter, F. (2015). Patient drawings of their melanoma: A novel approach to understanding symptom perception and appraisal prior to health care Psychology & Health, 30 (9), 1035-1048 DOI: 10.1080/08870446.2015.1016943
American statistics show that breast cancer is the second leading cause of cancer-related deaths among women, and yet only a third of women regularly check their breasts for signs of the disease*.
Now research by Jamie Goldenberg and colleagues suggests existential angst could be a key factor that is putting women off self-checking.
In a morbid context, being reminded that we’re made of flesh and bone, just like other animals, can exacerbate existential angst. In an initial study, Goldenberg’s team showed that female university students who read an essay about the similarity of animals and humans, and who were asked to think about their own mortality, were subsequently less likely than a control group of students (who imagined a painful dentist visit) to say they planned to check their breasts.
Another experiment timed how long women checked their breasts for after they either read an essay about the similarity of animals and humans, or about the uniqueness of humans. There was a trend for the group who read about the similarity of animals and humans to spend less time self-checking.
There was a further twist to this last experiment. Earlier on, the women had been asked to taste a new proto-type health drink, with half of them told it was supposed to be calming and the other half told it was an energy drink, which may cause nervousness.
Among the women who read the essay about the similarity of humans and animals, and who were therefore expected to experience existential angst, only those who had drunk the calming drink spent a reduced amount of time checking their breasts. The researchers said this is because whereas all these women were presumably feeling uncomfortable, thanks to existential angst, those who’d tasted the energy drink were able to attribute their discomfort to the anticipated nervous effect of the energy drink, thus leading them to persevere longer with their self-checking.
“Applied health workers only stand to gain by considering whether interventions and instructional materials can be delivered in ways that reduce the likelihood of casting breast self-examination in a creaturely light [i.e in ways that don’t remind women of their mortality],” the researchers concluded. _________________________________
GOLDENBERG, J., ARNDT, J., HART, J., ROUTLEDGE, C. (2008). Uncovering an existential barrier to breast self-exam behavior. Journal of Experimental Social Psychology, 44(2), 260-274. DOI: 10.1016/j.jesp.2007.05.002