Blame hurts

Blame is one of the most tragic and hurtful consequences of today’s popular belief that by eating and living ‘right’ we can stay healthy and prevent diseases, such as cancers. Today’s culture promotes the idea that “wellness” and disease are under our control and even a matter of mind over matter. So, those who get sick, naturally blame themselves for having not done something right or are blamed by others.

Many people believe that diet, obesity and mental outlook can make a real difference in their chances for getting or surviving cancer, but can they?

In debunking mythologies and fears surrounding health and wellness, we’ve examined a number of studies testing these beliefs. For instance, the recent WHEL (Women’s Healthy Eating Living) study, one of the largest and most comprehensive diet prevention studies ever done, found that eating a diet rich in fruits and vegetables and chocked full of antioxidants, low in fat and high in fiber had no affect on the recurrence of cancers among breast cancer survivors.

This study also examined if having a positive mental outlook and surrounding oneself with supportive, upbeat people can help cancer patients live longer. They found it made no difference.

Yet, no matter how many studies have disproven this prevailing mind-body connection, the belief continues. Sadly, it leaves cancer patients ridden with guilt when they’re told they have cancer, and feeling like they have to put on a smile, when they might really feel like crying at times. The saddest thing is to hear of cancer patients who believe that, for their survival, they mustn’t be around people who don’t radiate positive energy. So some distance themselves from old friends — ones who often feel as afraid and devastated by their cancer as they are. In doing so, they often lose an irreplaceable compassionate shoulder; one that would give them permission to cry when they need to.

Sadness and hope and surviving cancer

A new study published in this month’s issue of the journal Cancer is especially worthy of note, as it’s the largest study of its kind to date. It tested the hypothesis that emotional well-being and mood predicts survival in cancer patients with some of the most disfiguring forms of cancers — ones that involve especially difficult treatments to keep smiling through. Head and neck cancers can leave its victims with parts of their faces and jaws removed, and unable to speak or eat.

Dr. James Coyne, Ph.D., and colleagues from the University of Pennsylvania examined the quality-of-life assessments done on 1,093 patients enrolled in two Phase III clinical trials of treatments for head and neck cancers at their radiology oncology group. The evaluations done at the beginning and during the trial included the FACT-G scale, from which they measured 27 aspects of well-being, such as levels of sadness, hope, nervousness, worry about dying or the cancers, and confidence in how they were handling their condition. A total of 646 patients died during the trials, but the researchers found “no statistically significant association between well-being and survival.”

Their results held even when factoring for the stages of the cancers, smoking, marital status and income. Not only the large number of deaths, but the fact that all of the patients were getting the same treatments, gave the researchers greater ability to control for confounding factors that could influence survival and their study results. Despite exhaustively attempting to show a link between mental outlook and prognosis, they could find “no support for the hypothesis that negative emotional well-being predicts poorer survival.”

Of course, it doesn’t mean that depression in cancer patients doesn’t affect their quality of life or that it’s pointless to treat depression. Nor does it mean that patients can't be comforted by their faith. It just means patients have one less thing to worry about and can have the peace of mind that comes in knowing their emotions aren’t going to cause their cancers to grow faster or slower, and that their cancer isn’t their fault.

The authors made an important cautionary note about all of the studies finding a “correlation between depression and cancer incidence and progression.” They found that the literature was dominated by studies “with small, heterogeneous samples and inadequately assessed and controlled clinical variables,” making meta-analyses inappropriate. Echoing other researchers, they cautioned against combining flawed studies, especially with small sample sizes, into a meta-analysis, which would cause the poorer, small studies to be considered in the same context as larger, better controlled studies. We can never simply tally the number of studies supporting a particular belief — quality is what counts when coming to the soundest conclusions.

And, null findings like this one hold special value in helping to prevent us from heading astray, just as it helps keep researchers from pursuing unproductive directions. The journal Cancer Epidemiology Biomarkers & Prevention even has a section of Null Result studies.

One such study earlier this year offered another valuable message that could reassure countless women with ovarian cancer, and their families, about another belief often used to worry them about poorer prognosis or blame them. Yet, sadly, it received no media attention at all.

Obesity and cancer survival

Oncologists evaluated 409 women diagnosed with ovarian cancer at Roswell Park Cancer Institute in Buffalo, New York, between 1982 and 1998 and followed them for 9 to 23 years. The strengths of this study were its large sample size and long follow-up period. As part of their clinical assessment at enrollment, the women’s heights, current weights and usual weights prior to diagnosis were recorded. The researchers examined if fatness affected the women’s prognosis in these hormonally-mediated cancers. While it’s popular to believe that obesity reduces chances for survival, that’s not what they found.

Ovarian cancer survival was not associated with ‘overweight’ or ‘obese’ at all. Being fat did not reduce the women’s prognosis. Nor did the researchers find tenable associations between survival and medical conditions associated with obesity. The most important factors were the grade and stage of the cancer, followed by advanced age at diagnosis.

The researchers overviewed the studies published to date that have examined BMI as a potential prognostic factor for women with ovarian cancer. The first, conducted by oncology researchers at Duke University Medical Center in Durham, NC, and the Centers for Disease Control and Prevention, found no association between overweight or obesity and survival among more than 250 women in the Cancer and Steroid Hormone Study. One observational study, suggesting a link between obesity and prognosis, suffered from flaws, such as being a small cohort of Chinese women, most of whom had low BMIs, with very few women even overweight to make a meaningful conclusion. The last two reporting associations with cancer recurrence or deaths were also flawed, finding, for example, untenable hazard ratios. Reminding readers that associations found in these observational studies do not mean causation, the researchers said that rather than looking at obesity itself, authors have suggested that obesity’s potential ability to affect cancer prognoses is through other mechanisms, such as poorer diagnostics or suboptimal chemotherapy dosages given fatter women.

Knowing that things like cancer, diseases of aging and death often just happen, and that religiously following some ideal diet or lifestyle can’t change that, might be a scary thought to some, but it’s also empowering knowledge. It can free us from the oppression of guilt and blame, help prevent us from becoming obsessed with following unsound beliefs that take advantage of our fears, and leave us more able to enjoy life to the fullest. Not live it in fear and guilt.