Researchers led by Maggie Watson, PhD, of the Royal Marsden Hospital in Sutton, England, studied 578 women recently diagnosed with early-stage breast cancer and found a "fighting spirit" did not appear to affect survival. Fighting spirit is defined as "a determination to fight illness and adopt an optimistic attitude." In the study, feelings of helplessness, hopelessness, and depression were measured by standardized tests at the time of diagnosis and one year after diagnosis. The women were followed for at least five years. After five years, the researchers found there was an increased risk of death for women who were depressed, but there were no significant results for the category of "fighting spirit."

Women with Breast Cancer May Feel Depressed

The finding may seem paradoxical, but Dr. Watson points out that what is most significant is the recognition that a woman diagnosed with breast cancer may feel depressed, helpless, or hopeless. "It is important to say that many women with breast cancer will feel low and helpless from time to time. This might be normal given what they are coping with. Patients who find it difficult to maintain a positive fighting spirit all the time should be relieved of the worry and guilt that they might be causing their cancer to progress. We can now reassure them that this is not so," Dr. Watson said.

However, she advised women who continue to feel those emotions to seek help. Psychological therapy or antidepressant therapy can often effectively treat these distressing symptoms, she said.

Dr. Watson also advises women to be cautious of the claims of alternative cancer therapies. Alternative methods are defined by the American Cancer Society (ACS) as unproven or disproved methods, rather than evidence-based or proven methods to prevent, diagnose, and treat cancer.

"I hope this study will limit the promises made by alternative therapists who claim their therapy will give women a positive attitude, which will help patients survive," she said. While alternative methods may help improve the quality of life, Dr. Watson urges women to question what those methods can achieve in relation to their cancer prognosis.

In an accompanying editorial, Jim B. Tucker, MD, of the University of Virginia Health System described the study's findings as further evidence of "the need to develop treatment approaches that address the patient as a whole."

Care Should Include Emotional Dimension

Dr. Watson agreed, "Cancer care must be seen to encompass more than physical care and include the emotional dimension," she said.

The researchers encourage doctors to look for signs of depression and feelings of hopelessness in people with cancer. "Recent research from the US shows serious depression among cancer patients continues to go under-diagnosed. [Doctors should] treat these responses vigorously to help women improve the quality of life and optimize length of survival," Dr. Watson added.

While these findings are hopeful, the study authors and Dr. Tucker emphasize the need for more comprehensive research regarding the relationships between patient psychology and disease outcome. "Future research needs to clarify how these responses impact prognosis, see if these results can be replicated elsewhere, and determine whether the findings apply to other types of cancer," Dr. Watson concluded.