Tennessee resident Shannon Rollins is three years cancer-free from HER2-positive breast cancer now, but the path to this point was a tough one. Her initial treatment protocol lasted for an entire year and included chemotherapy, a double mastectomy and reconstruction. Although she tried to maintain a positive attitude most of the time, some days were harder than others. "I was pretty good at staying positive with outsiders. My family of course got to see my hard days," she recalls. "I felt like a burden to them when I couldn't process a complete thought and my body was weak."
Indeed, statements like "stay positive" and "attitude is everything" are what many people tell their loved ones going through cancer treatment. But is this mentality truly helpful to actually surviving cancer? Unfortunately, the answer is no. Studies reveal that a consistently positive attitude has no impact on cancer survival rates, according to the American Cancer Society.
For instance, a 2010 analysis of several studies on whether being positive or having a "fighting spirit" could improve cancer survival rates or extend the lives of people with cancer found there was no evidence of this. In fact, claims that the immune systems of cancer patients are enhanced by "positive psychology" were deemed implausible, and called "bad science" by the scientists who analyzed the research. "We urge positive psychologists to rededicate themselves to a positive psychology based on scientific evidence rather than wishful thinking," the study authors concluded.
Worse, patients confronted with the unrealistic demand of never-ending positivity are likely to feel even more burdened when they're confronted with the understandable anxiety, depression and other upset that so often accompany cancer diagnosis and treatment. Another study suggested that belief in positive thinking may lead people to think that cancer patients are to blame if they do not recover from the disease.
It's unrealistic to expect a cancer patient to remain positive all of the time, especially in the early days of diagnosis. "Cancer makes your life explode," says Elaine Smith, M.S., L.M.F.T., behavioral health therapist at Cancer Treatment Centers of America (CTCA) Atlanta, noting that there are many stressors that come with a diagnosis, including emotional, financial, work-related and family concerns. "On top of it is the biggest question: Am I going to live or die?"
The good news, however, is that realistic, balanced positivity can make certain aspects of the process more bearable.
What Exactly Is a 'Positive Attitude'?
Many people associate a "positive attitude" with being happy and peppy and looking on the bright side all the time. However, the concept is actually far more nuanced, especially as related to cancer patients.
"A positive attitude is realistically seeing the situation as it is with a balanced outlook on both pleasant and unpleasant realities," says licensed clinical social worker and therapist Sara Kouten, founder of SafeWaters Therapy, a practice that specializes in grief and trauma support for people undergoing cancer or other chronic illnesses. "When a 'positive attitude' is present, my clients can compartmentalize the negative and experience joy. They realize that happiness is not dependent on the absence of hardship," she says.
It's no small feat to get to the point where a cancer patient can accept the ups and downs of treatment with grace, however. Often, patients turn to specialized therapists to help them learn to cope. "A positive attitude is something that you gain, you work towards," says Smith. "I think it has a great sense of hope. Patients should never feel guilty because it changes from day to day."
The Real Role of Positivity in Cancer Treatment
Although positivity won't kill cancer cells, it can help people maintain an attitude that is helpful while experiencing cancer and may encourage them to follow their treatment plan and take their doctors' advice. "When people have a positive outlook, they are able to find peace with reality. They have hope. When there is hope, there is increased compliance," says Kouten.
The Mayo Clinic also points out that having a positive attitude can encourage patients to stay active, maintain ties to family and friends, and continue social activities, all things that may help them to feel better during and after cancer treatment.
Former cancer patient Rollins would agree. "I looked for the positive in the process. It was not all fun, but I found ways to make most of it," she says, such as getting to spend quality time with her friends while undergoing hours of chemotherapy. She also found a support group through the Red Door Community, which was started by actress Gilda Radner.
Nurturing Positivity During Cancer Treatment
Smith doesn't use the word "positive" with her patients at CTCA, opting instead to nurture an "environment of hope." CTCA therapists teach skills to patients that can help them have healthy days throughout treatment, but the idea is to look at life only one day at a time. Patients are encouraged to set goals, express gratitude and hope, then think only about the day they're in, since many worries about the future are either out of their control, or probably won't come true, anyway. "We're going to jump the hurdle for that day only," Smith says.
One of the coping mechanisms that Smith's patients learn is the concept of mindfulness. "It's an incredible skill that's brought about by relaxation and using your breath," she says, adding that it helps a person, "relieve yourself of the wandering mind," which so often produces fear and depression.
Learning mindfulness is easy enough to do from home, and isn't time-consuming at all. In fact, she says to start at two sessions per day, five minutes only. Smith suggests looking up "mindfulness breathing exercises" on YouTube or using an app like InsightTimer. During the mindfulness lesson, she says to sit comfortably, close your eyes and breathe.
"When an intrusive thought comes into [your] head, send it on a cloud or send it down a stream and go back to the breath," she explains. "It isn't the thought that's the problem, it's pursuing the thought that's the problem." In the beginning, many patients are skeptical that this form of meditation is effective, but Smith says that it is shown to reduce anxiety, depression, sleep problems and pain.
It's also critical for cancer patients to have an outlet to express negative feelings. These emotions, says Kouten, are, "valid and real and need to be expressed (appropriately) in order to process and move on to more 'positive' feelings." Journaling and talk therapy are excellent ways to express these emotions.
But if a person is having a hard time having hope, it's probably time to talk it over with their care team. Depression can be disabling, and affects 15 to 25 percent of cancer patients, often requiring treatment. Many cancer centers, such as CTCA, offer programs and services designed to help patients throughout the process.
Rollins has now been cancer-free for three years. Although she still has regular follow-up visits and has to take medication, she's been one of the lucky ones for whom cancer is fading into memory.
"I made a decision to not focus on the cancer once I completed treatment and wanted to focus on adventures and living," she says. "I do like that cancer is not a part of my everyday life anymore."