Commentary

Linking survival to psychological state is a contentious issue in cancer care. At one end of the spectrum, various “positive” emotional states are held to have a benign and potentially curative influence on outcome. At the other end are those for whom such ideas are anathema and dangerous. In this debate sound data are sparse. Faller et al's study goes some way to redressing this lacuna. The participants in this study had lung cancer—an unusual group in this area of research, often ignored perhaps because of the relatively poor prognosis of this type of cancer. Various measures, both psychometric and structured interview, were used, and although these may be relatively unfamiliar to non-German readers, they seem to cover much the same issues as more widely used measures. One common criticism of research in this area is that biomedical variables are not taken into account. No such criticism can be levelled at this study and the analyses used multiple covariates.

The key finding was that a depressive coping style and interviewer rated distress were both significantly associated with reduced survival times in conjunction with tumour stage and general physical state (performance status). This is an important finding and one that has been noted in women with breast cancer.¹ What may be equally important, and of great clinical importance, is that in neither report was there any suggestion of influence in the other direction—that is, a non-depressive coping style (in Watson et al's terminology “fighting spirit”) enhancing survival. Patients may be told—with the best possible motives—to “think positive” as this will help them to survive the cancer. This is often an additional burden for people who are already struggling with a lethal disease and extremely burdensome treatments. Patients often report feelings of self recriminating blame for “letting people down,” or that they are censoring expressions of sadness or fear because this is seen as not being positive enough. The message from both these reports is that we should be focusing our clinical efforts on helping patients to deal with their depression and to develop their anti-depressogenic coping skills.