Other mechanisms besides the immune system may also play a role in spontaneous remission, according to Caryle Hirshberg, coauthor of Spontaneous Remission: An Annotated Bibliography and a consultant for the Institute of Noetic Sciences (the term “noetic” here relates loosely to mind-body connections). The bibliography provides the most comprehensive review available of the published literature on spontaneous remissions. Reports included in the bibliography indicate that some cancers regressed after they outgrew their blood supply and underwent necrosis, or tissue death. This observation led researchers to develop antiangiogenesis drugs that inhibit the growth of new blood vessels. Bevacizumab, the first angiogenesis inhibitor approved by the FDA, is in use now to treat colon cancer. Other patients improved when they experienced changes in their estrogen, thyroid, or growth hormone levels. Some patients improved after marked temperature elevations, with or without infection. Finally, a number of reports suggest that some emotional, spiritual, or mind-body connection may have induced a spontaneous remission.
The scientific evidence that mind-body connections might induce self-healing is limited and conflicting. Nonetheless, some patients and physicians believe the mind plays a powerful role in both the development of cancer and its treatment. Alice Epstein, a mathematician and sociologist, was diagnosed in 1985 with cancer of the kidney and told she should have her left kidney removed right away. One month after having her left kidney removed, the cancer spread to both her lungs, and she was informed she had just two to three months to live. Like Matzke, she was advised to undergo immediate treatment. Epstein, who says she had a “cancer-prone personality,” then turned to psychosynthesis, which she describes as a “combination of psychotherapy and spiritual therapy.” It helped her overcome depression, difficulty expressing anger, and suppression of her own needs in order to please others—traits she and some psychologists believe are characteristic of the cancer-prone personality. Although she never received any medical or surgical treatment for the deadly cancer invading her lungs, six weeks after starting psychosynthesis, her tumors began to shrink. Within one year, they had disappeared without a trace. That was 22 years ago. Epstein, now healthy and 80 years old, tells her story with good-natured grace. But she acknowledges that despite contact with many other people with cancer, she has not met anyone who had a spontaneous remission as she did, despite their efforts.
The problem with anecdotes is that they can so easily mislead; it doesn’t take long to find anecdotes that tell a different story. Dr. O’Donnell recalls a patient of his with metastatic colon cancer. The patient, whom we’ll call Don R., was told by his surgeon he had just six months to live. O’Donnell says R. became so distraught that he constantly checked the calendar on his watch, and as each new month ticked forward, he grew more and more anxious. On the night his watch was to tick forward to the six-month mark, O’Donnell had to hospitalize R. for his distress. He placed the patient directly across from the nursing station where he could be closely monitored. The man lived through the night—and went on to survive another 14 years, as his cancer never progressed (he eventually died of a pulmonary embolus). But for those 14 years, R. continued to check his calendar anxiously for the passage of every month. O’Donnell says he tells this story as a reminder of how difficult it is to make a precise prognosis, but R.’s story also challenges assumptions that anxiety and stress lead to a bad outcome while positive feelings automatically bring a positive outcome.
Doctors know that case reports can lead to flawed conclusions. Cause and effect can be confused. Unrelated events may be thought to be related. If, as some people believe, the mind can have a positive influence on the immune system—which in turn can fight off cancer—it would stand to reason that R., who was terribly stressed, might have been expected to do very badly. On the other hand, patients like Matzke and Epstein could skew perceptions about mind-body effects through a form of reporting bias called the survivor effect. The survivor effect occurs when only surviving patients tell their stories, leaving out those patients who may have tried positive thinking or prayer but died. Collections of such case reports can be highly misleading. To determine whether an intervention is truly effective, researchers must perform clinical trials that compare all patients treated with an intervention. Unfortunately, there are few such studies, and those that exist have led to conflicting results.
The most celebrated study showing a dramatic reduction in mortality with psychological support was performed by David Spiegel, a professor at the Stanford University School of Medicine. Spiegel’s study, published in 1989 in The Lancet, showed that women with terminal breast cancer who were enrolled in supportive therapy had a significant survival advantage over women who were not enrolled in support groups. But several well-performed studies since 1989 fail to reproduce the finding. A study published in The New England Journal of Medicine (NEJM) in 2001 found no survival benefit for the 158 women randomized to support groups compared with the 77 women who were not enrolled in the groups. It did, however, show that women who were in support groups experienced an improved quality of life.
None of the patients from the groups could be interviewed because they have all died, and the groups were disbanded at the end of the study, according to Patricia Fobair, who co-led the support groups with Spiegel. Fobair, a clinical social worker who was herself diagnosed with breast cancer in 1987, recalls one of the group patients, an engineer, who came to the group depressed and with marital problems. With encouragement from the support group, the woman went back to school to become an artist, resolved her marital problems, and became someone who was “fulfilled,” according to Fobair.
Despite conflicting study results, doctors agree that our minds clearly do have some effect on our physiology and overall health. When frightened, our hearts race, our palms become sweaty, and our pupils dilate. Stress can cause changes in the function of the immune system, including reducing the number of natural killer cells that are known to battle cancer. An entire field of study called psychoneuroimmunology now examines such connections. Weinberg, who says he used to doubt claims that mental states could affect the course of cancer, now wonders. To show why, he pulls out a raft of study results collected in a large three-ring binder and points to several studies showing that mice subjected to stress developed more cancers than normal mice. The effects of stress can be profound. A fascinating study published in NEJM last year found that the newly bereaved—those who had lost a husband or wife within the past month—have a 53 to 61 percent increase in the risk of death.
Yet attempts to harness the power of the mind or spirit to induce self-healing through techniques like prayer, support groups, therapeutic touch, and meditation have been largely disappointing. For example, doctors at Duke University thought that prayer might help patients who were undergoing cardiac surgery for stent placement. But when they concluded a multicenter study of intercessory prayer for their patients, there was no reduction in six-month mortality. Similarly, a study of “therapeutic touch” published in the Journal of the American Medical Association showed that practitioners who insisted they could sense a patient’s “energy field” proved incapable of even sensing the presence or absence of a test subject’s hand. In that study, therapeutic touch practitioners, prevented from visually observing the subject’s hand, were able to locate the hand correctly in only 122 of 280 test runs—44 percent of the time, a rate roughly equivalent to chance alone (50 percent). The authors of a 2006 study published in the Journal of Clinical Oncology did find that breast cancer patients who had more social ties survived longer than did socially isolated women. However, the authors concluded that socially isolated women fared worse because they had less access to medical care.