A diagnosis of cancer can cause significant emotional burden for patients and their families. The turmoil may persist throughout treatment and even years into survivorship. As a result, depression and anxiety are two to three times more common in cancer patients than the general population. In a perspective paper published September 23 in the journal Trends in Cancer, experts propose that targeting cancer patients' mindsets could have an impact on their health, functioning, and well-being, and they call for more research in this field.
"We spend millions of dollars every year trying to cure and prevent cancer," says co-author Alia Crum (@AliaCrum), a psychologist at Stanford University. "But cancer is more than a physical disease. 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."
Mindsets are core assumptions individuals hold about the world. When facing the same situation, such as a cancer diagnosis, people may have very different mindsets about what it means for their life. Mindsets are not necessarily true or false, but they affect what people think and how they behave. Therefore, mindsets can influence individuals' mental and physical health.
After advances in neuroscience and psychology in the past decades, the link between mind and body has gained wider recognition. However, which specific mindsets have the greatest impact on the health and well-being of patients with cancer and how they do so are just starting to be investigated.
Researchers stress that as cancer treatment becomes more precise and customized, psychological treatment also has the opportunity to become more effective if targeted specifically.
The article presents two pairs of specific mindsets that could impact cancer patients' health: regarding cancer as either a catastrophe or an opportunity and seeing the body as either a friend or a foe.
Researchers argue that empowering patients to shift their mindsets could completely alter their cancer experience. Instead of catastrophic thinking, viewing cancer as manageable and recognizing the body as capable and resilient may motivate patients to participate in activities and initiate lifestyle changes like eating heathier and getting exercise. Patients may become less afraid of side effects from treatment and cancer recurrence afterward.
"We are not talking about positive thinking here," Crum says. "Having the mindset such as cancer is manageable or even an opportunity does not mean that cancer is a good thing or you should be happy about it. However, the mindset that 'cancer is manageable' can lead to more productive ways of engaging with cancer than the mindset that 'cancer is a catastrophe.' What we hope for patients is to inspire them to think about the impact of their mindsets and give them skills to adopt more useful mindsets themselves."
In the current standard of care for cancer patients, although support groups and other resources are available to help with patients' overall psychological health, mindsets tend to be overlooked.
"Cancer clinicians do what they can to provide guidance and support and reassurance to help patients and to deal with difficulties," says co-author Lidia Schapira (@l_schapira), a practicing oncologist at Stanford University. "But that doesn't mean that they're delivering any really sophisticated mental health interventions."
Researchers propose that "wise interventions," which are timely and context-sensitive interventions that targeted individuals' mindsets, could be used to help cancer patients. Although this approach has been shown to be useful in other domains, such as helping disadvantaged students do better in school and helping people manage stress more effectively, it has not been explored in the field of oncology.
The team is currently conducting experiments, including randomized-controlled trials with cancer patients, to obtain robust data on how mindsets can affect cancer treatment outcome and patients' physiological health and what types of interventions can be most supportive.
These interventions don't necessarily require in-person clinic visits, says first author Sean Zion (@seanrzion), a doctoral student at Stanford University. "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."
"This research is still in its infancy," says Crum. "But 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."
Trends in Cancer, Zion et al.: "Targeting Mindsets, Not Just Tumors" https://www.cell.com/trends/cancer/fulltext/S2405-8033(19)30176-1
Trends in Cancer (@trendscancer), published by Cell Press, is a monthly review journal that presents and debates the latest opportunities, impasses, and potential impacts of basic, translational, and clinical sciences but also discusses emergent relevant issues in pharma oncology R&D, technology and innovation, ethics and society, and current cancer policy and funding models. Learn more: http://www.