"Fighting spirit" after cancer diagnosis does not improve outcome
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《英国医生杂志》
Having a fighting spirit in response to a diagnosis of breast cancer does not improve the chances of survival, according to new research that tracked more than 500 women for 10 years. But women who were classed as having a helpless or hopeless response to their diagnosis were more likely to relapse or to die.
In the study, which was published online ahead of print in the European Journal of Cancer (doi:10.1016/j.ejca.2005.01.012), researchers looked at psychological responses to diagnosis, including helplessness or hopelessness and fighting spirit, and compared them with outcomes 10 years later.
All the women in the study had originally presented at the Royal Marsden Hospital. At its outset the study involved 578 patients aged 18 to 75 years with early stage (I and II) breast cancer. After 10 years 307 women (53%) were alive and were without relapse, 49 (9%) were alive with relapse, and 221 (38%) had died. One patient was lost to follow-up.
The report, which acknowledges as contentious the idea that psychological response to diagnosis can influence the outcome of disease, shows that women who had originally been assessed as helpless were at greater risk. After 10 years the risk of death from breast cancer or relapse in women with high initial scores of helplessness or hopelessness was greater than that in the other groups (adjusted hazard ratio 1.53 (95% confidence interval 1.11 to 2.11)).
"The results showed that in patients who were disease-free at five years, their baseline helpless/hopeless response still exerted a significant effect on disease-free survival beyond five (and up to 10) years. The effect is therefore maintained up to 10 years of follow-up," the report says.
The analysis also shows that a high fighting spirit confers no advantage in survival. "The data confirm that there is no benefit to survival of a fighting spirit beyond five years post-diagnosis. This is an important result as it may help to remove any continuing feelings of guilt or sense of blame for breast cancer relapse from those women who worry because they cannot always maintain a fighting spirit or a positive attitude."
The authors, from the Royal Marsden Hospital and the Institute of Cancer Research, say that although the findings show an effect of early psychological response on long term survival, they do not explain how or why a helpless or hopeless response to diagnosis has an effect on disease free survival.
Various possible mechanisms have been suggested, including an effect on immune status, effect on stress hormones, and behavioural changes associated with psychological response that may impede effective treatment.
"Having found evidence of an adverse impact on disease-free survival of a helpless/hopeless response at 10 years post-diagnosis, the aim now would be to clarify the mechanisms of action and develop suitable therapies in order to help improve outcomes in these women," says the report.
The authors add that there may be benefits to screening patients in the early stages of cancer so that psychological therapy could be offered to those who show high levels of helplessness or hopelessness.(Abergavenny Roger Dobson)
In the study, which was published online ahead of print in the European Journal of Cancer (doi:10.1016/j.ejca.2005.01.012), researchers looked at psychological responses to diagnosis, including helplessness or hopelessness and fighting spirit, and compared them with outcomes 10 years later.
All the women in the study had originally presented at the Royal Marsden Hospital. At its outset the study involved 578 patients aged 18 to 75 years with early stage (I and II) breast cancer. After 10 years 307 women (53%) were alive and were without relapse, 49 (9%) were alive with relapse, and 221 (38%) had died. One patient was lost to follow-up.
The report, which acknowledges as contentious the idea that psychological response to diagnosis can influence the outcome of disease, shows that women who had originally been assessed as helpless were at greater risk. After 10 years the risk of death from breast cancer or relapse in women with high initial scores of helplessness or hopelessness was greater than that in the other groups (adjusted hazard ratio 1.53 (95% confidence interval 1.11 to 2.11)).
"The results showed that in patients who were disease-free at five years, their baseline helpless/hopeless response still exerted a significant effect on disease-free survival beyond five (and up to 10) years. The effect is therefore maintained up to 10 years of follow-up," the report says.
The analysis also shows that a high fighting spirit confers no advantage in survival. "The data confirm that there is no benefit to survival of a fighting spirit beyond five years post-diagnosis. This is an important result as it may help to remove any continuing feelings of guilt or sense of blame for breast cancer relapse from those women who worry because they cannot always maintain a fighting spirit or a positive attitude."
The authors, from the Royal Marsden Hospital and the Institute of Cancer Research, say that although the findings show an effect of early psychological response on long term survival, they do not explain how or why a helpless or hopeless response to diagnosis has an effect on disease free survival.
Various possible mechanisms have been suggested, including an effect on immune status, effect on stress hormones, and behavioural changes associated with psychological response that may impede effective treatment.
"Having found evidence of an adverse impact on disease-free survival of a helpless/hopeless response at 10 years post-diagnosis, the aim now would be to clarify the mechanisms of action and develop suitable therapies in order to help improve outcomes in these women," says the report.
The authors add that there may be benefits to screening patients in the early stages of cancer so that psychological therapy could be offered to those who show high levels of helplessness or hopelessness.(Abergavenny Roger Dobson)