Changing Cancer Patients' Mindsets Could Enhance Their Care

Fran Lowry

October 09, 2019

Sheila K had just been diagnosed with colon cancer. She was in shock. Just hearing the word "cancer" made her think that it was the end of her world. How was she going to cope with chemotherapy? Surely she was going to lose her hair, her job, and how on earth was she going to pay for her treatment?

Such catastrophizing thoughts are common, and many people who are diagnosed with cancer have them, researchers say.

"Mindsets are used in many ways, but we define mindsets as the core assumptions we make about things in the world," Alia Crum, PhD, a psychologist at Stanford University, in California, told Medscape Medical News.

"The world is a very complex place, and the human mind has a very small capacity to comprehend and make sense of a very complex reality, so mindsets are simplifying systems that lend a frame of mind that helps us make sense of this complex reality," Crum said.

"When facing a cancer diagnosis, people may have very different mindsets about what it means for their life. We have found through our initial research that people tend to have mindsets that reflect this idea that cancer is a catastrophe, that it is going to ruin all aspects of their lives, that it is going to have this pervasive negative effect," she said.

Crum, along with coauthors Sean Zion, a PhD candidate at Stanford, and Lidia Schapira, MD, an oncologist at Stanford University, have written a perspective article on the subject of mindsets and their influence on psychological well-being and physiological health in cancer patients in Trends in Cancer.

The article presents two specific mindsets that could affect cancer patients' health. In one, cancer is regarded as either a catastrophe or an opportunity; in the second, the body is regarded as either a friend or a foe.

"I was very interested in learning what people's core assumptions are about what it means to have a chronic illness like cancer. Those two categories of mindsets seem to be important in predicting patients' health and well-being as they go through treatment and even long after," Zion told Medscape Medical News.

"We have pilot data suggesting these mindsets are really important and are now working on a randomized control trial to see how these mindsets impact health and well-being," " he said.

A patient's mindset is not contingent on the objective clinical reality of the cancer. It relates to physical and social functioning, perceived health, and quality of life.

It's important to point out that mindsets are not positive thinking. Dr Alia Crum

"It's important to point out that mindsets are not positive thinking: just think positively about your cancer and it will be cured. Mindsets are impactful because they color what we pay attention to, they change our motivations, and they can also have an impact on our physiology," said Crum.

"For example, I've done a lot of work on mindsets and stress and have found that when you believe or hold the mindset that stress is debilitating, that it is bad for you, the body's stress response is actually worse than when you hold the mindset that stress is positive and energizing. This negative belief changes hormonal levels and increases the stress hormones like cortisol and DHEA [dehydroepiandrosterone]. We don't know for sure yet if these mindsets about cancer matter, but we do know that other mindsets have impact physiologically," she said.

"We spend millions of dollars every year trying to cure and prevent cancer, but cancer is more than a physical disease," she continued. "As we strive to target malignant cells with the latest cutting-edge treatments, we should simultaneously strive to provide equally precise treatments for the psychological and social ramifications of the illness."

The Power of the Mind

Coauthor Schapira told Medscape Medical News: "As a medical doctor with no training in mental health but training in cancer medicine, I have always been impressed by what I call the power of the mind. I've always understood that the mind and a person's beliefs certainly impact how someone copes with an illness like cancer and therefore has a very important impact on quality of life."

She has witnessed this in her own practice.

"I've seen patients who have been on pain medicines who made a real effort to use nonpharmacologic ways of dealing with their pain or their distressing physical symptoms and how that can play a role in overcoming a physical problem," she said.

"I've seen patients who had very poor prognoses but with the power of their minds are able to celebrate every moment they have, whereas others are totally defeated. I think there is a tremendous amount of potential in beginning to think about how we can help patients and families to think about their future health in ways that can be soothing, comforting, and can give them strength to handle uncertainty," Schapira said.

"As an oncologist and someone who is very interested in cancer survivorship, I see every day that anxiety and fear of cancer recurrence can cause a lot of emotional distress. Our work here has been to think about how we can design interventions that harness this power of the mind and help people think about how they can go forward and move on," she said.

The interventions would not necessarily require in-person clinic visits, Zion said.

"There have been so many advancements in digital health platforms in recent years. We think that one way to push this forward is by creating scalable mindset interventions that can be widely distributed to patients, the type that they can do at home on their own time, where they are comfortable taking in new information," Zion elaborated.

This research is still in its infancy, they emphasize.

"We are working hard to uncover the specific mindsets that may interfere with patients' ability to be resilient in the midst of cancer, and more importantly, which specific mindsets can be cultivated that can really improve their well-being. We are devoting blood, sweat, and tears to these questions because we believe that cancer patients deserve the most sophisticated psychological care," said Crum.

Crum, Zion, and Schapira report no relevant financial relationships.

Trends Cancer. Published online October 5, 2019. Abstract

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