Reply to Decreased cancer survival in individuals separated at time of diagnosis: Critical period for cancer pathophysiology?
Article first published online: 9 JUL 2010
Copyright © 2010 American Cancer Society
Volume 116, Issue 21, pages 5111–5112, 1 November 2010
How to Cite
Sprehn, G. C., Chambers, J. E. and Johnstone, P. A. S. (2010), Reply to Decreased cancer survival in individuals separated at time of diagnosis: Critical period for cancer pathophysiology?. Cancer, 116: 5111–5112. doi: 10.1002/cncr.25241
- Issue published online: 9 JUL 2010
- Article first published online: 9 JUL 2010
We read with interest the letter by Hanisch and associates regarding our publication and offer the following comments. Despite their assertions, the main point of our report1 was the specific finding regarding separation versus other categories of the unmarried in cancer survival, not the impact of psychosocial interventions on survival. We recognize and should have noted that there is conflicting evidence with regard to the latter issue. One perspective is articulated particularly well in a scholarly article by Coyne et al.1
In their letter, Hanisch et al take issue with 1 possible interpretation of the results we reported. However, the references provided by Hanisch et al generally are supportive of our interpretation and our recognition of the need for further research. Specifically, Chida and colleagues3 concluded from their meta-analysis that stress-related psychosocial factors have an adverse effect on cancer outcomes, although those effects vary according to the type of psychosocial factor, the disease site, and patient outcomes. They also concluded that the future of this area of research will require a focus on the assessment processes in parallel with outcomes and the consideration of whether strategies for stress control may complement behavioral and medical strategies for the prevention and treatment cancer. Furthermore, Cohen and colleagues,4 whose study we cited in our original article, noted that the consistent research findings regarding psychological stress and disease strongly support the hypothesis of a causal link. Cohen et al also noted that the development and demonstrated efficacy of interventions to reduce the behavioral and biologic sequelae of psychological stress in randomized clinical trials would provide critical data on the clinical importance of this work.
Despite mixed results, we consider it a mischaracterization to refer to the entire field of psychosocial intervention as invalid. There is a large body of work supporting stress-immunity hypotheses.5 Scientific debate always is welcome and, in particular, additional data would be especially useful. We recommended more research into the mechanisms underlying our main finding and agree that conclusions and recommendations should be evidence based. We hope our findings on separation spur such further research.
- 1Decreased cancer survival in individuals separated at time of diagnosis: critical period for cancer pathophysiology? Cancer. 2009; 115: 5108-5116., , , , .
- 2Psychotherapy and survival in cancer: the conflict between hope and evidence. Psychological Bull. 2007; 133: 367-394., , .
- 3Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008; 5: 466-475., , , .
- 4Psychological stress and disease. JAMA. 2007; 298: 1685-1687., , .
- 5Neuroendocrine modulation of cancer progression. Brain Behav Immun. 2009; 23: 10-15., , , .
Gwen C. Sprehn PhD*, Joanna E. Chambers MD*, Peter A. S. Johnstone MD*, * Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana.