Mind Over Cancer

To make Americans aware of psychology's value, I made getting the word out about psychologists' role in cancer treatment a priority during my term as president of the American Psychological Association. Learn all you can. You never know when you or someone close to you will need a psychologist's help to cope with this as yet incurable disease.

Three Months To Live

Kip Little was supposed to die a decade ago. When she was diagnosed with breast cancer in 1986, she was stunned. "I spent my lunch hours working out. I ate good things. I was a health nut,"—says Little, a former high-school counselor and physical education teacher in a Toronto suburb. "How could this happen to me?"

Following her mastectomy, a chance encounter led Little to a psychologist at the Ontario Cancer Institute. Working with him and other breast cancer patients, she transformed her life. Together they met weekly to discuss their feelings, learn meditation and other relaxation techniques, and explore ways of coping with grief, depression, pain and fear.

Finding the program was a lifesaver, says Little, now a 60-year-old retiree in Burlington, Ontario. "It was the skills I learned that got me through—and continue to get me through," she says. When her cancer returned in 1990, a physician gave her only three months or so to live. She rejected further physical treatment and instead intensified her practice of meditation and similar activities targeting her mental state. Today she's cancer-free.

Like Little, most people don't automatically associate psychology with cancer treatment. But they should. While psychologists can obviously help patients cope with the devastation of a potentially life-threatening diagnosis, their role often goes far beyond that. Psychologists teach patients how to endure the often difficult treatments that may represent their only chance at life. They improve patients' quality of life and help family members cope. As Kip Little's story illustrates, psychologists may even help extend patients' lives beyond conventional medicine's greatest hopes.

Living Longer?

Psychiatrist David Spiegel, M.D., of the Stanford University School of Medicine, launched the debate about whether psychological interventions can lengthen lives in 1989, when he published a now-classic paper describing his work with breast cancer patients.

In the study, patients came together in weekly group therapy sessions to express their feelings about cancer and receive support from fellow victims. When Spiegel followed up a decade later, he discovered that patients who had participated in the sessions had survived an average of 18 months longer than those in the control group. Years of controversy have followed, with researchers trying—with mixed results—to replicate Spiegel's findings.

Now the psychologist who treated Kip Little believes he has the first real evidence that psychological interventions can indeed prolong lives. Like many others, Alastair J. Cunningham, Ph.D., senior scientist at the Ontario Cancer Institute, has spent years trying to determine group therapy's actual impact.

At first, he had little luck. Using an intervention he calls "Spiegelplus," Cunningham led 30 women with metastatic breast cancer through nine months of weekly group therapy. Patients also completed assignments such as attending religious services. An addition all 36 patients received a workbook and audiotapes designed to teach them relaxation and mental imaging. To his disappointment, Cunningham could detect no difference in survival rates between the two groups when he checked five years later.

Then Cunningham realized that a randomized study wasn't the right approach. Although randomized studies are the gold standard of scientific inquiry, they hide individuals and their behavior behind general findings.

To find out how his intervention affected individuals, Cunningham substituted a correlative design for a study of 22 patients with various kinds of supposedly incurable cancer. After asking experts to predict each patient's life-span, Cunningham and his team painstakingly gathered data on each participant's attitudes and behaviors as they participated in an intervention along the lines of the earlier experiment.

The result? Cunningham found that patients like Kip Little and other "superstars"—people who worked the hardest at transforming themselves psychologically—lived at least three times longer than predicted. With one or two exceptions, the least active died right on schedule. "It makes sense to me that the people who live longer are those who make substantial psychological changes," says Cunningham. "Of course, only a few do that."