The claim that psychotherapy extends survival has moved from controversial to implausible

Resources to accompany the blog post

Doubts a Classic Lancet Study Showed Psychotherapy Improves Survival of Cancer Patients

Below are critiques of the idea that psychotherapy promotes survival of cancer patients. Some of these papers are critiques of particular studies, while others are systematic reviews. Some of the links that are provided take you to abstracts, others to PDFs or slide presntations.

I don’t think any of the authors started out as rejecting the possibility that psychotherapy could promote survival. I think that if you queried them, all would say that they really wish that it was possible to change the course and outcome of cancer with psychotherapy or other psychosocial interventions, but they have become convinced that it is a harmful illusion.

We need to be aware of unintended consequences of suggesting cancer patients can exert control over their condition for their morale.  The grande dame of psycho-oncology, Jimmie Holland wrote that patients

feel guilty that they can’t control their illness… They look upon it as a weakness, partly as a result of the culture’s emphasis on psychological means of controlling cancer.

The earliest skeptics about the 1989 Lancet study  were epidemiologist Bernie Fox and Stanford oncologist Wallace Sampson. They came under considerable attack when they tried to voice their concerns.

We owe a lot to them for their having the courage to speak out, and the consequences that they had to endure as a result. There are still strong vested interests protecting the notion of mind over cancer. Personally, I’ve experienced letterwriting campaigns, pressures on editors to reject papers or retract them, rescinding of offers to speak and aggressive personal interactions. I know the same is true for other skeptics and critics.

The number of the authors of these papers had devoted parts of their careers to trying to show that psychotherapy would extend survival. They expressed their despair in their titles: “time to move on” and “letting go of the hope.”

Boesen, E. H., & Johansen, C. (2008). Impact of psychotherapy on cancer survival: time to move on? Current Opinion in Oncology, 20(4), 372-377.

Coyne, J. C., Hanisch, L. J., & Palmer, S. C. (2007). Psychotherapy does not promote survival (Kissane et al., 2007): now what? Psycho‐Oncology, 16(11), 1050-1052.

Coyne JC, Palmer SC. Does psychotherapy extend survival? Methodological problems overlooked in Kuchler et al.’s (2007) conclusion. Journal of Clinical Oncology. 2007;25(30):4852-3. [PDF]

Coyne, J. C., Palmer, S. C., & Stefanek, M. (2006). Can we bury the idea that psychotherapy increases the survival of cancer patients?. Psychology and Health. 21 (34) [Slideshow]

Coyne, J. C., Stefanek, M., & Palmer, S. C. (2007). Psychotherapy and survival in cancer: the conflict between hope and evidence. Psychological Bulletin, 133(3), 367-94. [PDF]

Coyne, J. C., Thombs, B. D., Stefanek, M., & Palmer, S. C. (2009). Time to let go of the illusion that psychotherapy extends the survival of cancer patients: Reply to Kraemer, Kuchler, and Spiegel (2009). 135(2), 179-182

Daniels, J., & Kissane, D. W. (2008). Psychosocial interventions for cancer patients. Current Opinion in Oncology, 20(4), 367-371.

Fox, B. H. (1998). A hypothesis about Spiegal et al.’s 1989 paper on psychosocial intervention and breast cancer survival. Psycho-Oncology, 7, 361–370.

Fox, B. H. (1999). Clarification regarding comments about a hypothesis. Psycho-Oncology, 8, 366-367.

Kissane, D. W. (2007). Letting go of the hope that psychotherapy prolongs cancer survival. Journal of Clinical Oncology, 25(36), 5689-5690. [PDF]

Kissane, D. (2009). Beyond the psychotherapy and survival debate: the challenge of social disparity, depression and treatment adherence in psychosocial cancer care. PsychoOncology, 18(1), 1-5.

Palmer SC, Coyne JC. Examining the evidence that psychotherapy improves the survival of cancer patients. Biological Psychiatry. 2004;56:61-2.

Palmer SC, Stefanek ME, Thombs BD, Coyne JC. Psychologic intervention and survival: wishing does not make it so–letter. Clin Cancer Res. 2010;16(21):5364-5. [PDF]

Ross, L., Boesen, E. H., Dalton, S. O., & Johansen, C. (2002). Mind and cancer: does psychosocial intervention improve survival and psychological well-being?. European Journal of Cancer, 38(11), 1447-1457.

Sampson, W. (2002). Controversies in cancer and the mind: Effects of psychosocial support. Seminars in Oncology, 29, 595-600.

Stefanek, M. (2013). Controversies in Psycho-Oncology. In Psychological Aspects of Cancer (pp. 157-175). Springer US

Stefanek M, Palmer SC, Thombs B, Coyne JC. Finding What Is Not There: Unwarranted claims of an effect of psychosocial intervention on recurrence and survival. Cancer. 2009;115(24):5612-6. [PDF]