The SIO Research Committee is pleased to offer this fourth installment in a new blog series known as "Myths of Cancer". In this series we will address some of the most common myths and misperceptions that arise around cancer risk and treatment related to diet and natural health products, as well as other complementary therapies such as yoga, acupuncture and meditation. If you have a question you'd like us to address or comments about this post, please send your suggestions to: firstname.lastname@example.org.
We hope you enjoy the series!
Linda Carlson and Eugene Ahn, Research Co-Chairs.
5 Common Myths About Cancer and Cancer Treatment that Could Harm You
By: Eugene Ahn, MD
Quick Answer Box
Sometimes we can hold on to our belief systems too tightly. Below, we discuss some myths about cancer that evidence suggests may negatively impact a patient’s chances of surviving a cancer diagnosis. We have intentionally excluded controversies that will be addressed in future blog entries.
A new diagnosis of localized cancer can be an emotional rollercoaster of ups and downs, dread and optimism, fear and empowerment. Added to this distress is the seemingly impossible task of gathering sufficient information to make the best evidence-informed decision regarding an optimal individualized treatment plan. It is only natural (with the lack of any editorial oversight on most information posted on the Internet), that someone could accidentally pick up some erroneous beliefs about cancer and cancer treatment and likewise miss out on important new research insights that would improve cancer treatment outcomes. In this blog, we discuss myths that already have sufficient research to show they are not only incorrect, but also may harm a patient’s chances for thriving after a cancer diagnosis. We interviewed surgical oncologists, medical oncologists and other cancer care providers to identify the most common harmful myths that they encounter in their practice. These myths are listed in order of least to most harmful.
5. After completing treatment aimed at curing cancer, the most important thing to do is to have lab and imaging tests to make sure the cancer does not come back
There are some cancers where lab tests and routine imaging are important for optimal outcomes, such as testicular cancer. But for other cancer types, we are clearly over-testing without any evidence that such practices improve outcomes. For example,in the case of breast cancer, some practitioners or patients will insist on obtaining tumor markers (blood tests for proteins that can be elevated if the cancer expresses it) despite the fact it is already established as an unreliable screening marker for breast cancer. The negative side-effects of using such tests can be huge. Imagine having an elevated cancer marker and the emotional turmoil that you would experience thinking you have a possible cancer recurrence, only to find out one year later after repeated images and tumor markers (and likely biopsies) that it is not the case. It would be more impactful to focus on primary prevention: i.e. promotion of lifestyle behaviors that would help prevent another cancer, and in some cases, reduce chances of cancer recurrence. This includes a healthier diet, more physical activity and mind-body practices, and continued secondary prevention (such as a screening mammogram, when appropriate).
4. If my doctor recommends that I see a psychiatrist or psychologist for additional consultation, they must think I’m crazy.
One of the biggest remaining stigmas about cancer care is no longer the word “cancer”, but anything that begins with the letters “psych”. In fact, that is precisely one of the reasons why supportive care clinics are not called “psychosocial care” or “psychological support”, but use terms like quality of life or survivorship clinic. But it is really an unfounded fear. People with emotional distress who receive care from a qualified mind-body support professional do significantly better in terms of both cancer-related quality of life and minimizing side effects from treatment. In fact, the ones who need mind-body support the most, often tend to be the very ones who refuse to acknowledge this as a missing essential component in their healing plan. Oncologists know that cancer treatment can be tough physically and emotionally, and their referrals to a mind-body expert are basically their way of saying there are better, more qualified specialists who can help you with the emotional rollercoaster ride that is cancer. Those that receive care from a mind-body specialist often emerge from cancer treatment with what is called “post traumatic growth” or in simpler words, a silver lining to their cancer experience. This “positive meaning” to their cancer experience has huge implications in terms of emotional well being after cancer treatment is completed.
3. It’s not cancer that kills people, it’s the cancer treatment.
While it is true that injury and even death can occur with conventional medicine and/or errors made by personnel within cancer centers, it is in the striking minority. A common narrative on alternative health websites is that when patients have metastatic cancer and receive chemotherapy, that it is the chemotherapy that ultimately kills the patient, not the cancer. This is an easy hypothesis to test. If that were true, then you would have data that consistently shows patients with cancer who die, had chemotherapy in their last month of life. In fact, when you track most cancer centers, you will find that very few patients who die from cancer, received chemotherapy in their last month of life. In a study that garnered a lot of press attention, researchers found that in England, on average 8.4% of patients with lung cancer and 2.4% of patients with breast cancer died within a month of receiving chemotherapy (Wallington et al, Lancet Oncology 2016). In fact, chemotherapy given within the last month of life is a measure by which insurance companies will measure the quality of care given at a cancer center (less treatment in the last month of life is encouraged). According to this myth, we should also be seeing scores of patients in hospice care or self-care rebounding miraculously when freed from the toxicity of chemotherapy, but unfortunately that is not reflected in the statistics. It is true that a surprising number (35%) of oncologists polled on whether they would take chemotherapy (this was before the approval of immunotherapy) if diagnosed with metastatic non-small cell lung cancer would not. However, it is erroneous to assume that this data meant those physicians believed chemotherapy would kill them. They were simply willing to acknowledge that if they were dying, they would rather focus on the time left to connect with family and get their affairs in order.
2. I can think my cancer away with positive thoughts
Probably the greatest misunderstanding regarding mind-body medicine is that you can treat cancer by simply focusing on positive thoughts or imagery. Clinical trials looking at positive visualization have been negative for overall survival with cancer, but they do help reduce anxiety and improve some measures of quality of life and may even impact immune and other biological processes. However, there is no evidence that positive thoughts result in cancer regression or cure. The idea that having negative thoughts will bring back your cancer is simply wrong and can be very psychologically harmful. In fact, one of the most powerful mind-body therapies, mindfulness meditation, emphasizes becoming a non-judgmental curious observer of ALL that is transpiring in our ‘mind’, being inclusive of both “good” or “bad” emotions and thoughts. By embracing and not fearing our negative emotions or thoughts we can then gain personal insight into what is the real cause of those phenomena, and often it is discovered that these are conditioned responses, related to past experiences but not necessarily probable outcomes in the present. The healthiest way to relate to emotions is to acknowledge, accept and experience them as they are, allowing them to come and go as they will with the recognition that all things are passing and impermanent, and not harmful.
1. I can’t do surgery on my cancer because “oxygen will feed the cancer” and make it more aggressive.
Perhaps as expected, mainly the surgeons interviewed for this blog entry reported encountering this myth, which would clearly make a patient reluctant to have their cancer surgically removed or biopsied. There are a lot of reasons why surgery might not be the best option for you (for example, it is already metastatic and spread), but when it comes to curative intent treatment of almost all solid organ cancers, surgical removal is usually the most impactful intervention to achieve cure. In fact, for pre-cancerous lesions like colonic polyps and DCIS of the breast, surgical removal alone is highly effective for prevention of evolution into malignancy and it is known that without surgery and just observation the risk of these becoming more aggressive in biology and clinical stage increases the longer you wait to remove those lesions. This belief system is more often found in African-American and Latino patients (Ann Int Med 2003), and correlates to delay or refusal of surgery. If this belief were true, however, we would expect to rarely see cases of metastatic breast cancer in patients who did not have a prior biopsy or surgery for breast cancer. Unfortunately, we know that as many as 6-10% of patients who are diagnosed with breast cancer present with metastases without a prior biopsy or breast surgery. In summary, there are much more influential factors one should be worried about (biology of the disease, genomic changes in the cancer, lifestyle choices) than being afraid of surgery.