We hear it all the time: “Cancer is a battle”—insinuating that patients have to fight in order to increase their chances of a good outcome. It’s a common message used in the media, the premise being that a person’s cancer can be eradicated if they are tough enough.
But does this put the burden of healing on patients by turning them into winners and losers? Does it saddle those who aren’t doing well with the added guilt of not having fought hard enough? And how much does a person’s attitude really matter in the grand scheme of their cancer treatment?
In this podcast, we examine these question and more—plus some strategies for how patients, caregivers, and survivors can deal with mental health issues and emotional stress that can result from cancer treatment and survivorship—with Bill F. Pirl, MD, MPH, vice chair of Psychosocial Oncology at Dana-Farber Cancer Institute.
MEGAN: So, to start off, could you just tell us a little bit about what you and the Department of Psychosocial Oncology and Palliative Care focus on at Dana-Farber?
BILL F. PIRL, MD, MPH: The Department of Psychosocial Oncology and Palliative Care at Dana-Farber focuses on quality of life for patients, both in terms of physical symptoms as well as psychological symptoms. Dana-Farber Cancer Institute was the first cancer center that recognized the need for psychosocial care, and we had the very first oncology social worker here in 1968.
MEGAN: Great. So, to get right to it, is there a benefit to viewing cancer as a battle? Or is this really a myth that should be eradicated?
PIRL: I think it is controversial…for some people, it may be helpful to look at it in a way that gets them motivated or shifts them to action and doing something for their cancer. But for many people, it’s not, and actually, there’s a famous book that was written in 1977 by Susan Sontag called Illness as Metaphor specifically around how it can be harmful using metaphors like that and set it up as winners and losers. So, when somebody might have cancer progression or when things don’t go in the way that they were hoping, they may feel like they didn’t do enough or like they lost the battle.
It also is very violent. It sets up ways to think about doing very violent things to your body and cancer treatment as doing extreme measures in order to achieve “victory” over this “enemy.” So it can actually make some people feel worse in terms of not doing enough for their cancer, and it also sets up a dynamic that is kind of not what people expect in wanting to be cared for in cancer treatment [in] this peaceful environment.
Also, there are a lot of metaphors just in our everyday language that talk about cancer in warlike terms that can also be harmful for people, too. [For example,] when they talk about something being a cancer in an organization that you need to cut out before it kills things. It’s not helpful for people to hear that, and cancer really shouldn’t be used as a metaphor in that way.
MEGAN: So, is there evidence that a person’s personality traits can affect outcomes? It was once kind of thought that people with certain personality traits were more susceptible to cancer.
PIRL: Yeah, so back in the 1940s through the ‘60s, there was a lot of interest in that, in how specific personality traits could actually cause cancer or predispose people for cancer. Some of the research was funded by the tobacco industry…as we started to learn that cigarettes could cause cancer, they were trying to fund alternative facts for how cancer might be caused by other reasons. So, that research isn’t really looked at in the same way now as it was then, and generally, today, we don’t believe that personality factors influence cancer development.
MEGAN: Ultimately, can a positive or negative attitude affect a person’s outcome, or is that a myth? And if that is a myth, are there still benefits to having a positive attitude?
PIRL: I think that’s complicated. I think the belief that people need to have a positive attitude all of the time in order to do well with their cancer is a myth, that it isn’t just having a positive attitude. I always say it’s more doing positive things. It’s positive actions by going to your appointments, of doing the things that you need to do for your medical care, taking care of yourself, staying socially connected. It’s really these positive actions and not necessarily thinking in your mind, “Everything is great!”
And I often tell patients—because sometimes people can feel like they could be contributing to their cancer worsening when they have bad days, or when they’re having thoughts that they can’t be positive…it’s physiologically impossible to be vomiting and positive at the same time. Your body just can’t do that.
And the research has been mixed about this, whether positive attitude (in however way people define it for the research study) might be helpful, and generally, there’s not a lot of evidence in the research to support it.
MEGAN: So, to your point, some may say that adapting a positive attitude is way easier said than done, so for people who are struggling with depression or anxiety or dealing with emotional stress in general, what tips would you give for addressing these problems as much as possible?
PIRL: I think, first, of not blaming yourself, because when people may have depression or anxiety [or are] not feeling positive, [they] could be thinking that they’re doing something to the cancer and feeling guilt over themselves doing that, which I think they shouldn’t do…I also think [it’s important] to also talk to other people about it, letting the people who you’re close to know about how you’re feeling, [and also talk] with your oncology treaters about it.
Depression and anxiety aren’t weaknesses. They’re not personal weaknesses; they are medical issues that sometimes could use medical treatment. Medical treatment doesn’t necessarily mean medications, but it could mean psychotherapy or counseling, and sometimes these are really needed in order to help with some of these symptoms getting better.
It can be scary to think about going to see a social worker or psychologist or psychiatrist about depression or anxiety, but many cancer centers try to make it as easy as possible and try to make it seem like it’s just part of routine cancer care, which it is. Sometimes, letting people know how common it is, that about 30 percent of people will have depressive or anxiety symptoms that could use talking with a mental health professional to know that they’re not by themselves….there are things you can do for it.
MEGAN: So, for someone who is listening, are there any web resources that you might recommend? Any places people could go if they want to learn more and need help for their depression or anxiety?
PIRL: National Cancer Institute has a lot of good educational pages that cover quality-of-life issues. There are a few national organizations that specifically focus on psychosocial aspects of cancer. One of those is Cancer Support Community. Cancer Support Community offers no-cost counseling and groups for people who are affected by cancer, and these could be online. Another online resource would be Cancer Care, which is based out of New York.