A Skeptical Look at “Mind-Body Medicine” for Cancer Patients

Peter Moran, M.B., B.S., B.Sc.(Med), F.R.A.C.S., F.R.C.S.(Eng)
March 5, 2006

Part of the appeal of “alternative medicine” is its offer to put cancer patients back “in control.” This is in part a reaction to the submissiveness expected of patients in more paternalistic and authoritarian medical circles. Mind-body approaches purport to offer people more personal control over their fate. All very fine, but those with cancer would be wise to ensure that they are not simply surrendering governance to equally controlling but less trustworthy influences.

The problem with cancer is that without aggressive treatment it is commonly relentless and largely resistant to most kinds of outside influence. I don’t need to prove that—it is such general experience that every testimonial depends upon the assumption that things would have gone badly were it not for the claimant’s luck in finding something that worked. Some types/stages of cancers have virtually a 100% mortality regardless of every effort by mainstream “alternative” practitioners, or the hopes. prayers and will of the patient. Even if mind-body concepts did occasionally work with some less aggressive or less advanced kinds of cancer, it can be argued that overall they do far more harm than good to cancer sufferers.

It is generally believed that support groups and other psychological aids can reduce anxiety and otherwise improve the quality of life of many cancer sufferers. This would presumably apply regardless of whether the support is from mainstream or “alternative” sources. Many go further and believe that a positive attitude or various mind-body practices can influence cancer survival. Some doctors think so. There is nevertheless very little support for this viewpoint in either general experience or from scientific studies.

The Evidence

Testimonial evidence is exceptionally weak, because it is rare for mind-body and closely related spiritual approaches to be used by themselves. Most people who profess to have overcome their cancer this way will have undergone standard treatments of known effectiveness. Many will also have used alternative methods, with no reason other than personal preference for emphasizing one component over any other. Such testimony should be interpreted as a manifestation of the person’s engagement in mind-body or spiritual practices; i.e. an expression of faith, or of the obligatory positive mental attitude, rather than a statement of observable fact.

Whenever this subject arises, one reported study is sure to surface, even though it has been shown to be flawed and the results could not be replicated in a larger, better designed study in which the original author also participated. The original study, reported in 1989 by David Spiegel, M.D., purportedly showed that attending a psychosocial support group could double length of survival in patients with metastatic breast cancer [1]. Even in that report, no patient is described as undergoing remission purely from the psychological support. In fact the support group had about the same prognosis as metastatic breast cancer in the general population. The results appear to have been due to unusually poor outcomes in the “untreated” group, supporting other evidence that the patients were not properly randomized. Patients not attending the support groups all died within 48 months, whereas metastatic breast normally has quite a few five-year survivors (15-20%). A subsequent study conducted at several cancer canters concluded that supportive–expressive group therapy might improve mood and pain perception but does not prolong survival in women with metastatic breast cancer [2].

Most other studies have shown no survival benefit from psychological interventions or any association of survival with patient states of mind, even while suggesting benefits upon patient anxiety and general well-being from involvement support groups. In my opinion, the evidence even for that is rather weak due to likely effects from patient selection and reporting biases, so I don’t think cancer patients should feel they have to seek out a that kind of support if they don’t feel the need. Wallace Sampson, M.D. has summarized the evidence [3].

Alternative practitioners, if pressed for an opinion on the usefulness of mind-body techniques in cancer treatment, will usually assert that cancer is best treated by a holistic approach in which mind-body and spiritual practices are merely an important component. This idea also lacks support. Obviously beneficial effects on cancer from any combination of alternative methods are quite rare—so rare that the findings are just as likely to be due to one of the many other reasons why cancer sometimes doesn’t behave as expected. I have outlined those in my essay <a href="http://members.bordernet.com.au/