Cancer, Charles, the King: The High and Low of Emotions

English Royal Family, June 2012.

Source: Carfax2 / Wikimedia Commons, CC

King Charles has been diagnosed with cancer, leading to worldwide speculation as to how the U.K. royal family and the monarch are going to cope emotionally with the dramatic news.

There has been a lot of attention given to how the previously alleged family rifts, involving supposedly Harry and William allegedly "falling out," may be impacted by the king's new cancer diagnosis.

The research into links between emotional states and cancer is at the cutting edge of the latest understanding of interactions between mind and body.

What may not be so widely known is that the emotional response to a cancer diagnosis can also impact the prognosis and the longevity of the patient. Obviously, the physical treatment that the patient receives is vital, and sometimes, hoping for a miracle leads some patients to opt for treatments with a poor scientific evidence base. Doctors believe, in that predicament, sheer hope and unrealistic optimism are more likely to contribute to an earlier demise.

It is unlikely that emotions just in themselves can cure or kill you.

However, a recent review of 51 studies, entitled Depression and Anxiety in Relation to Cancer Incidence and Mortality: A Systematic Review and Meta-analysis of Cohort Studies, found that the mental state of depression increased the risks of cancer incidence, cancer‐specific mortality, and all‐cause mortality.

Another study published in 2023 from Germany compared cancer incidence in patients with and without depression. The overall number of patients included in the study was 235,404, and an analysis of their data found that the incidence of cancer diagnosis overall increased by 22 percent for depressed patients, with the largest increased risk in lung cancer, cancers of the gastrointestinal tract, breast, and urinary.

The authors of the study concluded that depression increased the risk of cancer diagnosis consistently. The types of cancer showing the greatest increased risk due to depression (lung cancer, cancers of the gut, breast, and urinary system) are known to be strongly associated with risky behaviors such as smoking or conditions such as obesity, which are both about self-destructive actions known to be strongly associated with depression.

The authors of the study, entitled Depression Is Associated with an Increased Risk of Subsequent Cancer Diagnosis: A Retrospective Cohort Study with 235,404 Patients, contend that another potential shared mechanism of the disease may involve an inflammation-induced activation of the chronic stress response.

Another possible mechanism invokes sleep as a key factor, as the authors point out that sleep difficulties are common in patients with depression and may also be associated with cancer.

While investigating the role of negative emotions can be useful in assisting cancer patients' care, the role of positive emotions, such as hope and optimism, tends to be neglected by medical researchers.

A recent review entitled Happy Thus Survivor? A systematic review and meta‐analysis on the association between cancer survival and positive states, emotions, and traits examined 24 studies involving 822,789 patients. They concluded that positive emotions are associated with longer survival and lower mortality from cancer.

The authors of the review argue that those who report higher happiness and who are more optimistic deploy specific healthy activities associated with longer survival and avoid more hazardous actions.

For instance, optimism is associated with healthier actions such as more vigorous physical activity and better nutrition. Conversely, people who experience more positive emotions tend to steer away more easily from perilous undertakings, such as smoking or drinking alcohol, compared with those who experience more negativity.

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Another explanation might be that patients who are more positive experience specific physiological responses assisting their survival. Indeed, past research showed that positivity is related to specifically helpful physiological activity in patients with cancer, including inflammatory activity.

In addition to inflammatory activity, positive affect can impact a wide range of physiological factors such as blood pressure, cortisol levels, and immunity. These physiological impacts associated with positive affect could be a relevant mediator of the link found between them and reduced mortality in cancer.

However, is it possible the field has taken too simplistic a view of our emotional states and focused on negative or positive emotions as being merely the opposite of each other when, in fact, positive emotions perhaps should not be confused with merely the absence of negative emotions?

The latest thinking is that one can experience mixed emotions such that positive and negative might co‐occur. Experiencing mixed feelings might even be associated with better health.

A study entitled When Feeling Bad Can Be Good: Mixed Emotions Benefit Physical Health Across Adulthood argues that researchers have neglected the complex interplay between positive and negative emotions and how this impacts physical well-being.

The authors contend that "taking the good with the bad" may better benefit health.

The impact of mixed emotional experiences on health outcomes in a 10-year longitudinal study found that frequent experiences of mixed emotions (co-occurrences of positive and negative emotions) were strongly associated with better physical health.

The role that mixed emotions have until now remained relatively unexplored. Yet, when navigating life's ups and downs, "taking the good with the bad" may be optimal for physical health.

This may allow us to better confront adversity by finding meaning in negative events.

In this context, the widely reported official statement regarding the king's current mental state, which is that the king is as optimistic "as can be," having caught cancer early, becomes particularly psychologically and medically significant.