These data keep getting cited , demonstrating a persistent reluctance to exclude the fake data from consideration when they are impressively supportive of the view that mind matters in cancer. I cover these topics in my peer-reviewed papers, but also in my Skeptical Sleuth blog, which is designed to disseminate critical skills for interpreting both the scientific journals and media reports and to encourage a general skepticism towards these sources.
For my inaugural post here, I will touch on both of my major themes in discussing how the Journal of Clinical Oncology is not a reliable source for evidence about the relationship between cancer and the mind. JCO has a high journal impact factor of From time to time, I have challenged especially outrageous JCO articles, which are often accompanied by laudatory editorials.
No matter how fundamental the flaw being identified, the author of an article is the final judge of whether the critique will be published.
I co-authored the commentary with an eminent expert on posttraumatic stress disorder, Naomi Breslau and I have drawn on it with her permission and enthusiasm for my writing this blog. JCO, Dec 1;29 34 The authors drew parallels between NHL survivors and victims of disaster and violence. This article displayed some typical flaws found in psycho-oncology studies providing inflated estimates of psychiatric diagnoses from checklists administered to patients without involving a trained interviewer to explain to them what is being asked of them or probe their responses.
Also typical is that diagnosis was made on the basis of complaints that are nonspecific and common across health conditions which give patients good reason to worry about their future. The PTSD checklist used in this study was validated with combat veterans who had been exposed to a war zone, but who had left. The stressor was securely in the past for these vets, unlike for cancer patients facing a high likelihood of recurrence or actual recurrences.
A third of this sample of cancer patients had a recurrence before completing the questionnaire. These are not specific to PTSD, but are reasonable and expectable responses to actual or anticipated recurrence of cancer. More generally, these complaints become symptoms of PTSD only when they co-occur as part of a syndrome, not just in isolation, and when they can be linked to exposure to a past psychological threat.
The authors did not establish a syndrome or a link.
Psychoneuroimmunology and cancer: Incidence, progression, and quality of life - Semantic Scholar
If these cancer patients were actually suffering posttraumatic stress, the most empirically supported cognitive behavioral treatment would be exposure therapy, in which a patient is exposed to the traumatic situation with evidence that danger is no longer present, a luxury that current and former NHL patients do not have. I am skeptical that this treatment would benefit many NHL patients and that they would take up the offer of therapy until the threat of the disease was assuredly in the past.
I am disappointed that JCO let these authors decide that our critique could not be published and I remain quite interested in how they would have responded. Kuchler, T. Bestmann, et al. JCO,25 19 : This article claimed that an average of just minutes of psychotherapy produced a year survival benefit among a mixed group of patients with gastrointestinal cancer. Steve Palmer and I pointed out that preliminary reports of this clinical trial had designated quality of life as the primary outcome, but that no effect on quality of life was ever reported.
- How Can The God of Love Allow Suffering?.
- Psycho-oncology and cancer: Psychoneuroimmunology and cancer — the Research Networking System;
- Trust, Privacy, and Security in Digital Business: 11th International Conference, TrustBus 2014, Munich, Germany, September 2-3, 2014. Proceedings?
- The Mind in Cancer: Low Quality Evidence from a High-Impact Journal – Science-Based Medicine.
- Psychoneuroimmunology of Cancer – Recent Findings and Perspectives.
The authors conceded that no effect on survival had been hypothesized. There was no manual guiding this therapy, but patients received an eclectic mix of supportive talk therapy, crisis intervention, and a small amount of relaxation training, with considerable time taken up with strategizing and rehearsing interactions with oncology physicians and nurses. The oncology treatment team was aware of which patients were in the intervention group and the therapists spent as much time meeting with the surgical and nursing teams as with the patients. As a result, the patients assigned to psychotherapy got considerably more medical treatment: almost twice as many days of intensive care, and they were twice as likely to receive postoperative chemotherapy, five times as likely to receive radiotherapy, three times more likely to receive alternative treatments, and four times more likely to receive a combination of three treatments in the post-treatment period.
Psychoneuroimmunology and cancer
Furthermore, our inspection of the survival curves for the two groups indicated that an advantage for the group getting psychotherapy was observed immediately and lasted for a few months with no additional advantage accumulating in years 2 through 6. Better medical surveillance and treatment for patients getting talk therapy in this study are the most likely source of differences between groups, particularly since the investigators could not identify a possible mechanism by which talk therapy should influence survival.
As for a larger literature demonstrating that psychotherapy improves survival, the studies claiming an effect do not withstand scrutiny. JCO is a prestigious journal that frequently provides results of clinical trials of biomedical interventions.
I seriously doubt that the biomedical trials enjoy such relaxed standards for reporting or interpreting results or that a biomedical trial with such co-treatment confounds or increased surveillance given to the intervention group would go unchallenged. Steel, J. Geller, et al. Depression, immunity, and survival in patients with hepatobiliary carcinoma.
The Psychoimmunology of Cancer
JCO, 25 17 : The editorial called for research evaluating of interventions to reduce depressive symptoms that incorporated designs by which the effects on cancer progression and survival could be examined. This editorial refers to post hoc claims by Fawzy that his stress reduction intervention increased NK cell activity and improved survival in malignant melanoma patients to which.
My colleagues and I previously dispensed with this claim in a detailed critical analysis. Psychologist Paul Meehl has coined the term crud factor to indicate that negative affect variables like depression have so many antecedent, concurrent, and subsequent correlates that prospects for identifying tight causal models are bleak. If anything, what is surprising that is that cancer patients do not have higher rates of depressive symptoms. The efforts of these authors to show causality are thwarted by many factors, but most basically the small number of patients with depressive symptoms.
The simple unadjusted statistically significant relationship between depressive symptoms and survival would be undone by reclassification of one patient. And the use of multivariate statistics is simply inappropriate and prone to uncovering spurious findings. First, a mediational model would require demonstration of a simple statistical association between the mediator, NK cell activity, and survival, and there is none there. Second, with only 23 participants, the authors included at least 11 variables in their regression equation attempting to link depression to survival via NK cell activity.
It is difficult to believe that a statistician was involved in the peer review of this article.
It covers mechanisms mediating the effects of psychological status in the immune system, and anti-cancer mechanisms involving the immune system. Part II is clinically orientated, and accessible to a wide audience. Whether psychotherapeutic interventions can help patients live longer, as well as coping better, is obviously the key question and several contributors consider the clinical evidence for this. A new, speculative chapter on the spiritual context of immunity and cancer has also been added.
The psychoimmunology of cancer involves many complex issues, understanding of which remains far from complete. However, the contributors, besides reviewing the current state of knowledge and the implications for cancer patients, offer predictions for the future and ideas about further research. Psychospiritual healing and the immune system in cancer. Can psychosocial interventions extend survival?
A critical. Lewis , C. Ho , Ferry J. Jennifer Barraclough is a Consultant in Psychological Medicine.