Psychosocial Influences on Cancer Survival
David Spiegel Stanford University School of Medicine
Although on the one hand it seems implausible that psychosocial factors would have any effect on either the development or progression of cancer, it would be odd indeed if the large and complex nervous system we have evolved had no adaptive value. The purpose of this chapter is to review the evidence for and against an effect of psychosocial factors on cancer incidence and progression. Factors reviewed include personality traits, social support, and psychosocial intervention.
There are observations as far back as Galen to the effect that cancer patients as a group seem to be exceedingly cooperative, somewhat unassertive, and almost apologetic in their manner. These led to a more recent hypothesis that cancer patients as a group seem to suppress or be unaware of negative affects such as anger, and this has been formulated as a Type C personality ( Temoshok et al., 1985) in order to contrast it with the Type A characteristics thought to be predictive of heart disease. In contrast to the hostility and time impatience that typify the Type A, Type C patients are emotionally inhibited and use a repressive coping style ( Kneier & Temoshok, 1984; Greer & Morris, 1975; Temoshok & Dreher, 1992; Temoshok & Heller, 1985).
Early clinical observations of repressiveness in cancer patients ( LeShan, 1966) received support from Greer and Morris ( 1975) who found that breast cancer patients presenting for biopsy who had malignancies were more likely to endorse a Likert-type single-item scale to the effect that they never openly