COMMENTS ON BEATING THE BIG C

COMMENTS ON BEATING THE BIG C

Article by Grace Gawler

Having worked with people with cancer in a psychosocial support setting for 30 years, I applaud the implementation of the prevention principles outlined in "Beating the Big C" Australian 9 July 2005.

An ounce of prevention is worth a pound of cure so they say and it should be said that this is not new; naturopaths have been espousing the same principals for decades!

Importantly however, one thing was sorely absent from this report, the affects of stress and potent life changing emotional issues and how this also impacts on our health and the development of life threatening diseases such as cancer. In other words, as a disease and cancer preventive measure, looking after our psychological and emotional life may be just as important as the more physical aspects of prevention.

The issue has been that here are so many variables involved when attempting to study psychological-emotional precursors to illness as the results can vary enormously. A quick browse on Google can leave one in a total state of confusion; for instance the question of whether stress has an impact on the development of breast cancer or not?

In these days of evidence-based medicine, all studies including medically based studies will often refute the findings of the other. Although this probably creates some healthy academic sparring, it is the public who tend to be left in the cold as to what should they believe?

The good news is though that that these interventions, once a diagnosis of cancer is made, can be a tremendous addition to both the medical and complementary treatment that you may be receiving.

I have been a collector of studies related to both sides of this issue in order to attempt to balance and verify the results that I have witnessed anecdotally over 30 years; having worked with more than 10,000 cancer patients and their families. There is no doubt in my experience that offering care, hope, support and really being there for cancer patients, makes a positive difference to their outcome. But it is here too the waters become muddied by claims that people recovered with only meditation, diet, positive attitude etc. Many of these people in my personal knowledge, have had either initial surgery or medical treatment, to which they have added the complementary - supportive approach, and that it appears, is a great combination rather than just doing one or the other. Few people recover without any intervention and sometimes surgery itself can cause a spontaneous remission of secondary tumours when a primary has been removed. But on both sides, it is not as cut and dried, as some people would have us think.

A browse through some studies about both prevention and management of cancer can be helpful. If we look at some well respected literature, an article titled Stress and the gastrointestinal tract, published in The Journal of Gastroenterology and Hepatology, Volume 20 Issue 3 page 332 March 2005.

The authors Vikram Bhatia and Rakesh Tandon conclude that: " The pieces of the jigsaw puzzle linking the mind to the gut are being put together at rapid pace in research centres worldwide. As seeming are linked together, a clear picture is emerging of the profound influence that our thoughts and emotions have on our GI function. In the future therapies that target the ENS and CNS will assume greater roles and the chasm between "functional" and "organic" disorders will disappear." This review gives a fascinating understanding of the relationships of stress to various gut diseases and role of both prevention and management of illness.

A study on breast cancer published in Cancer Detection and Prevention 2004; 28(6):399 titled Psychological stress and the risk of breast cancer: a case control study, found that: " After adjustment for age and other potential confounders , we found that women with major life events, stress of daily activity, and depression, had 3.7 times higher risk for breast cancer, compared to those who did not experience such stress." Their conclusion, "These findings suggest an association between major life events and breast cancer."

This line of thinking also holds true for those who develop cancer. The addition of psychological and emotional recovery interventions both from anecdotal evidence and solidly structured research, are now known to positively affect patient outcomes, enhancing all important life quality and healing.

Emotional Support May slow Ovarian Cancer" was the title of an article by Anthony Brown, MD based on a study reported in the medical journal Cancer, July 15, 2005 and the report published by Reuters health information and available on Medline. Those with psychosocial support may fare better it said. The findings based on blood chemistry linked to psychosocial factors, studied 61 women who completed surveys regarding social support, distressed mood and quality of life before undergoing surgery for ovarian cancer. The findings were that IL - 6 levels (*interleukin) around the tumour may be one possible mechanism by which psychosocial support has a beneficial effect on ovarian cancer. High levels of IL-6 have been linked to faster progression and shorter survival time with ovarian cancer.

David Kissane et al published a brilliantly designed study in the MJA Vol 169 17 August 1998, where they looked at 303 women with early stage breast cancer entering a randomised trial of adjuvant psychological group-therapy.

The conclusion was" Women diagnosed with early stage breast cancer have high rates of psychiatric and psychological disturbance. Quality of life is substantially affected. Clinicians should actively explore patients' psychological adjustment to enable early recognition and treatment of these disorders."

"Coping Skills Affect Life After Breast Cancer" reports a study from Wake Forest University School of Medicine, North Carolina. They found that women with breast cancer had a lower overall quality of life than their counterparts without breast cancer. More than 7 out of 10 women with breast cancer said they experienced aches and pains and general unhappiness after diagnosis.

Dr. David Spiegel's results, released in The Lancet in 1989 , compared two groups of women with metastatic breast cancer (cancer that has spread to another organ or location outside the breast). In his study, Dr. Spiegel randomised the women into two groups, one of which met on a regular basis to talk about their feelings. The other group did not attend support sessions.
"Supportive-expressive group therapy" encourages participants to talk about how they are feeling, including fear, emotional issues, and family stresses, basically the whole gamut of concerns wrought by a cancer diagnosis. The group gathers on a regular basis with a trained therapist. Dr. Spiegel's results showed that the women in the support group lived longer. It was big news in the medical community. Someone had finally shown in a controlled study that there was efficacy in the "mind-body" arena."

Professor Julius Sumner Miller, for those that are old enough to remember his television science program; became my mentor when I was around eight years of age. He asked one pertinent question that has dominated my life since. "Why is it so?" If even one study shows a connection between stress and illness development then it is unscientific to not ask. "Why is it so?" How could this be? Dr Ainslie Meares, Australian psychiatrist said that, " A thing only needs to be done once to show that it can be done."

Wherever you stand it needs to be recognised that counselling and support interventions for people diagnosed with cancer and indeed other health issues, is imperative. As far as prevention goes, there enough studies telling us that as a preventive measure our psychological and emotional health may be just as important as what we eat.

Article provided by :

Grace Gawler

The Australian College of Supportive Care Medicine

Brisbane.