For Depressed Lung Cancer Patients, Life May Be Shorter

Can a positive outlook or fighting spirit extend the survival of cancer patients? Most studies exploring the question have, unfortunately, produced a negative answer. A few, however, have yielded a positive one.

And now comes still another study that suggests that a positive outlook—or at least absence of a depressive outlook—may be able to extend survival from cancer, and in one of the most intractable of malignancies, lung cancer.

The investigation was conducted by Hermann Faller, M.D., Ph.D., and Henrich Bülzebruck, Ph.D., of the Institute of Psychotherapy and Medical Psychology at the University of Würzburg in Wurzburg, Germany. The results were published in the December American Journal of Psychiatry.

Faller and Bülzebruck launched their study in 1989 to see whether a depressive coping style could influence survival in patients with lung cancer. Between 1989 and 1991, they recruited 103 patients newly diagnosed with lung cancer for the study. They made a point of selecting patients with different kinds of lung cancer so that they could take lung cancer type into consideration when analyzing their results.

Subjects were given a Freiburg Questionnaire on Coping With Illness. It included short statements designed to reveal whether the person filling it out engaged in a depressive manner of coping with illness or not—say, brooding, arguing with fate, pitying oneself, acting impatiently and taking it out on others, or withdrawing from other people. Subjects were asked to indicate, on a five-point scale, whether they agreed or disagreed with each statement and to what degree. A rating of 1 meant “not at all,” and a rating of 5 meant “very much.”

Faller and Bülzebruck then followed the outcomes of the 103 subjects until 2001. By this time, 95 of the 103 subjects had died. The researchers then attempted to see whether there was any link between subjects’ manner of illness coping a decade earlier and their length of survival.

Even when types of lung cancer, stage of lung cancer, and amount of chemotherapy were taken into consideration, subjects who had scored high on statements reflecting a depressive coping style lived, on average, only nine months, whereas those who had scored low on these statements lived, on average, 14 months.

“These results,” Faller and Bülzebruck concluded in their study report, “support the hypothesis that style of coping predicts survival in lung cancer.”

If there is indeed a link between a depressive coping style and lung cancer survival, however, the researchers admit that they can only speculate at this point how it might work—say, via neuroendocrine and immune pathways. In contrast, depression appears capable of shortening heart attack survival via cardiac autonomic nervous system activity (Psychiatric News, November 16, 2001).

The study was supported in part by a research grant from the German Ministry of Research and Technology.

The study, “Coping and Survival in Lung Cancer: A 10-Year Follow-up,” is posted on the Web at http://ajp.psychiatryonline.org/cgi/content/full/159/12/2105?. ▪

Am J Psychiatry 2002 159 2105