An Against the Grain Approach to Cancer : Health: Don’t expect early detection or a positive outlook to help you beat the disease, a USC professor says. He claims ‘nuts and bolts’ access to medical care is a more likely key to survival.
Can you increase your odds of surviving cancer?
Yes, says the author of a new analysis on cancer survival. But the way to go about it may surprise you.
Contrary to popular belief, survival is not influenced much by your emotional state, scientific discoveries, experimental treatments or, in some cases, even early detection, contends Howard P. Greenwald, a USC public administration professor. Even prevention is overrated, he argues, because most cancers can’t be avoided.
Rather, Greenwald says, once you’ve been found to have cancer, getting prompt, skillful, conventional medical care--what he calls “nuts-and-bolts access to good medicine”--is the best way to maximize your chances of survival.
Greenwald’s new book, “Who Survives Cancer?” (University of California Press), based on an extraordinary 10-year study of cancer patients and the factors in survival, questions many popular beliefs on the subject.
Although he does not dismiss the importance of spending money to study new therapies, prevention and the psychosocial aspects of illness, Greenwald says these things don’t matter much to the patient.
“I don’t want to diminish their value one iota,” says Greenwald. “But for an individual with cancer, the best chance of survival will be none of those things.”
Although several experts on cancer say Greenwald makes an important, scientifically sound argument, others question some aspects of his theory, such as his dismissal of the significance of emotional well-being and prevention.
Moreover, many cancer patients might not buy Greenwald’s whole argument, says Christine Perkins, a Los Angeles psychotherapist and social service director for the advocacy group Cansurvive.
“I think what he’s saying sounds pretty controversial,” says Perkins, a cancer survivor. For instance, she says, not many cancer patients feel at ease putting their fate entirely in the hands of their physicians. “There is a lot of anger toward the medical world by cancer survivors. We can’t always trust that doctors are going to know everything.”
Despite significant progress in treatment, about half of those who develop cancer die of it. Survival statistics have improved little in the past 25 years except for certain types of cancers, such as leukemia, according to the American Cancer Society.
“When you say cancer , most people think of white knights in white coats who will save them,” Greenwald says. “But . . . victory over cancer is not at hand.”
Greenwald’s observations, based on one of the few long-term studies to assess multiple factors in survival, included research into each patient’s clinical care, demographics, socioeconomic status, emotional state and physical function. Survivors were followed for at least 7 1/2 years.
Those with the highest income and education levels were most likely to survive, Greenwald concluded, because of prompt, conventional care with the standard treatments of surgery, radiation and chemotherapy. Patients with lower incomes fared best if they belonged to health maintenance organizations--perhaps also reflecting that unrestricted access to care is most important.
Does Greenwald have a point? Most people would probably agree that if all Americans had access to good health care, cancer survival rates would improve. According to a recent government report, uninsured Americans are three times more likely to lack medical care and to experience health problems.
Statistics also show that about 52% of white people with cancer survive five or more years, but among blacks, the five-year survival rate is only 38%. Greenwald’s book provides more evidence that this difference is probably attributable to access to care, says Dr. Charles Haskell, director of the cancer center at Veterans Affairs Medical Center in West Los Angeles.
“When people are given access to care, differences that appear to be racial disappear,” Haskell says. “I’ve always been impressed that the Veterans patients who take advantage of the system and get good care do well.”
But many cancer patients might dispute Greenwald’s contention that cutting-edge technology, prevention and emotional well-being matter little.
“I think things like support groups are important,” Greenwood says. “It’s a very good thing to do. I definitely think it’s good for people to share decision-making with their physicians. But in terms of a direct relationship between emotional well-being and survival, I don’t see any evidence of it.”
Still, having a positive attitude has become a popular concept in cancer treatment. (The idea was popularized by the late writer Norman Cousins.) In a recent survey by the Cancer Treatment Centers of America, 70% of nurses said they believed that a person’s state of mind was very important to recovery. Psychosocial support programs for cancer patients are widespread.
And many studies have found the opposite of Greenwald’s conclusion: Emotional well-being can influence survival, says Harold Benjamin, founder of the Wellness Community, which provides free emotional and psychological support to cancer patients.
“There is evidence that cancer patients who fight for their recovery with their health-care team instead of acting as passive victims will enhance the quality of their lives and may enhance the chances of their recovery,” Benjamin declares. “Can we guarantee it? Nonsense.”
Barbara Korito, who operates an advertising agency in Marina del Rey, had lymphoma. She believes that her survival--despite a relapse--had to do with a psychological re-evaluation of her life.
“I felt it was time to look at my life. I had a lot of deep-rooted psychological things I needed to clear up,” Korito says. “The people I see in recovery are clearing up all the stuff in their lives. You have to feel good about yourself. You have to come to some sense of peace.”
But Korito also says having financial resources and insurance mattered a great deal. Just before she began a long regimen of chemotherapy, she closed a big deal vital to her income.
“That allowed me the peace to lie down for six months and go through the treatment,” she says.
In West Hollywood, Seanne Biggs, found to have Hodgkin’s disease five years ago at age 23, says that a good emotional outlook indirectly helped her to survive.
“I think someone who has a healthy emotional disposition is going to take control of their lives a little better and help themselves make choices about medical decisions,” says Biggs. “If someone is so afraid and in denial and unaware and too scared to take hold of the situation, you can’t possibly make any decisions.”
Besides downplaying emotions, Greenwald suggests that cancer patients who enter clinical trials usually fare no better than those undergoing conventional treatment.
For example, studies show that most critically ill cancer patients who enroll in clinical trials designed to test experimental treatments add, at best, only a few months to their lives.
“For a successful clinical trial, you’re talking about a couple of months of increased survival time,” Greenwald says. “That can be significant for some people. But it’s not the kind of hope most people are looking for. People are looking for a treatment never tried before and walking away healthy, with decades of life ahead.”
But clinical trials can offer patients cutting-edge treatment that may soon become standard, counters Beverly Zakarian, president of the Cancer Patients Action Alliance, an advocacy group.
“The flaw in (Greenwald’s) argument is that clinical trials are intrinsically part of what will be the standard treatments of tomorrow,” Zakarian says. “Clinical trials also offer patients hope--and hope is important.”
Emphasizing emotional well-being--as well as prevention and experimental treatments--puts too much of the responsibility for cancer survival on the patient, allowing such issues as access and affordability of health care to be overlooked, Greenwald says.
“The individual has to be responsible for some things,” he says. “For instance, there are things you shouldn’t be exposed to that cause cancer. But too often the patient is blamed (for failure to beat the cancer) and the system gets off the hook.”
