I remember, years ago, I nursed two very similar patients on a ward. They were young males, same disease, same stage at diagnosis, and same treatment. They had very different approaches to their disease, and theyíre cases that have stuck in my mind.
One took it unflinchingly -- very optimistic that he would recover from his disease, coped with the treatments, and tried to continue his life despite his cancer. The other took to his bed, reverting to a child-like role, where his mother cared for him, even brought his quilt from his bed at home, and provided all his meals. He refused to get up, and his mum acted as go-between for him and the staff. The first young man did well, and the second didnít.
While there are so many other factors that may have influenced their disease trajectories and recovery, Iíve always wondered how much the role of positivity and optimism played in each case. The research is inconclusive. There are papers that say that hope and optimism play a role in cancer survival1, some that are unsure2, and others that conclude that the perceived need to be positive is actually potentially damaging to a patient as they try to hide symptoms in an effort to appear optimistic.3
I donít discount the value of optimism and hope in cancer care. Holistic ďwellnessĒ clinics can provide plenty of anecdotal evidence that positive thought may influence cancer survival. Indeed, there are many services, both legitimate and highly dodgy, that target hope and optimism in cancer patients. Iíve talked to many cancer patients who tell me that being optimistic is the only way they can face the next dose of chemo or the next blood test. As a coping mechanism itís completely genuine, but as an influence on the outcome of cancer treatment?
Again, anecdotally I think we all have cases we can reflect on. Possibly itís when hope and optimism are misplaced that negative outcomes are seen: The patient is still hoping for cure or remission, but in reality has a terminal disease, and thus he displays signs of depression, hopelessness, and physical symptoms as he becomes disappointed with the way reality is not meeting his expectations.
Cancer care, and coping with cancer, is about continually reevaluating the experience and adjusting psychosocially to it. Hope, positivity, and optimism can be reexamined and adjusted to fit, and outcomes are always good when this happens. Iíve seen great deaths in the face of appropriate hope, positivity, and optimism, and awful ones when these beliefs donít reflect the reality of the situation. I donít think hope and optimism necessarily change the outcome of a cancer diagnosis, but they certainly change the outlook.
- Dispositional Optimism Predicts Survival Status 1 Year After Diagnosis in Head and Neck Cancer Patients; http://jco.ascopubs.org/content/21/3/543.full.pdf+html
- Psychotherapy and survival in cancer: The conflict between hope and evidence; http://psycnet.apa.org/?fa=main.doiLanding&doi=10.1037/0033-2909.133.3.367
- Optimism and survival in lung carcinoma patients; http://onlinelibrary.wiley.com/doi/10.1002/cncr.20076/full