The news came this morning on Don Imus's radio show: the controversial and cantankerous radio personality has stage II prostate cancer. Immediately, friends and supporters invoked the common and combative language of survival. "Don is well-prepared to fight this," his spokesman Matthew Hiltzik said.
"The prognosis couldn't be better," Imus told listeners this morning. "I have great confidence in my doctors," he went on. "I'll be fine. If I'm not fine, then I won't be fine. And it's not a big deal."
Imus is absolutely right: His chances of survival couldn't be better. Consider one key statistic called the "relative survival rate." It measures the percentage of men who do not die from, say, prostate cancer after the disease is found. For all men with prostate cancer, according to the
American Cancer Society, the relative five-year survival rate is 100 percent and the relative 10-year survival rate is 91 percent. Over 15 years, the relative survival rate is 76 percent.
As of last Wednesday when he was diagnosed, Imus joined joined two million men living with prostate cancer in the United States (including 186,000 who will get the news this year). Imus says he has Stage II cancer, which means there is no evidence the disease has spread outside the prostate to other organs. Obviously, survival depends on a variety of case-specific factors. For instance, stage of the disease; the type of cancer cells (noted by the Gleason score); the PSA level (prostate antigen); the medical choices a patient makes; the quality of care that he receives; and his age and general health.
On all of those measures, Imus certainly appears to be in good position. He also should score well what's known as the "fighting spirit" or "will to live." Imus is a tough, combative guy, people will say, and he'll whip this disease like a defenseless guest on his show. But does the fighting spirit really make a difference in this kind of medical challenge? Can a positive mental attitude override a malignancy?
The answer:
Not as much as many people think or want to believe.
In October 1979, a British psychiatrist named Dr. Steven Greer rocked the medical world with a study in The Lancet, a leading medical journal. Dr. Greer found that women with breast cancer who demonstrated a "fighting spirit" survived longer. The study took place at King's College Hospital in London, and Dr. Greer grouped sixty-nine women into four categories: Fighting Spirit; Denial; and Hopeless; and Stoic Acceptance. After five years of study, 75 percent of the Fighting Spirit and Denial groups had "a favorable outcome" compared with just 35 percent of the Helpless and Stoic groups.
The 40 percent difference seemed stunning because no one had ever proven that the mind could triumph over the body or that psychology could prevail over biology. Of the women in this study who ultimately died, 88 percent fell into the Helpless and Stoic groups while only 46 percent of the women who remained alive and cancer-free had these negative responses.
Twenty years later, Dr. Greer co-authored a larger study in The Lancet of 578 women but this time the results were far less encouraging. Researchers "could find no survival difference when comparing one type of psychological response with another." Specifically, they were unable to uncover any evidence that a fighting spirit makes you live longer. "Our findings suggest that women can be relieved of the burden of guilt that occurs when they find it difficult to maintain a fighting spirit," they wrote.
On the other hand, persistent feelings of helplessness and hopelessness--the opposite of the fighting spirit--are bad for your health. Of those women who expressed beliefs like "I feel like giving up," only 58 percent were alive or in remission after five years, compared with 72 percent who did not feel hopeless or helpless. The authors concluded that the fighting spirit won't prolong your life, but helplessness and hopelessness may actually shorten it. "It is not what may be added in by fighting but what is taken away by being helpless that seems important in disease outcome," they wrote.
Dr. Greer is eighty years old now, semi-retired, and works one day a week as a psychiatrist at St. Raphael's Hospice in the village called Cheam in southwest London. He treats terminally ill patients experiencing anxiety and depression. He may be one of the pioneering authorities on the fighting spirit, but he doesn't sound like a man who's very convinced anymore about the power of the mind. He tells me that the fighting spirit is very hard to measure--that's why studies fail to prove its impact--and that a positive mental attitude exerts only "a modest effect" on the outcome of patients with cancer. Indeed, he says, the fighting spirit is "much weaker than biology."
While the fighting spirit may not influence your quantity of life, it will certainly improve the quality of your remaining time. People with the fighting spirit show "far far less" depression, anxiety, and other mental health problems, he says.
At age 68, Don Imus has a lot going for him in his confrontation with cancer. His medical choices and the quality of his care will make a big difference. And his notorious fighting spirit won't hurt either. But in terms of prolonging his life, it won't help nearly as much as most people think.
Originally published on The Huffington Post