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Having a positive attitude may help cancer patients deal with their disease, but it doesn't directly affect survival, according to one of the largest and most rigorously designed investigations ever to examine the issue.

The study included more than 1,000 people treated for head and neck cancer; the emotional state of patients was found to have no influence on survival.

The findings add to the growing evidence showing no scientific basis for the popular notion that an upbeat attitude is critical for "beating" cancer, says University of Pennsylvania School of Medicine behavioral scientist James C. Coyne, PhD, who led the study team.

"I wish it were true that cancer survival was influenced by the patient's emotional state," he tells WebMD. "But given that it is not, I think we should stop blaming the patient."

Does it help to keep a positive attitude?
People with cancer and their families may feel guilty about their emotional responses to the illness. They may feel pressure to keep a positive attitude at all times, which is unrealistic. This feeling of pressure can come from within themselves, from other people, or both. Sadness, depression, guilt, fear, and anxiety are all normal parts of learning to cope with major life changes, and a cancer diagnosis is a major life change. Trying to ignore these feelings or not talking with others about them can make the person with cancer feel lonely. It can also make the emotional pain worse. And some people feel guilty or blame themselves when they can’t “stay positive,” which only adds to their emotional burden.

Along these same lines, many people want to believe that the power of the mind can control serious diseases. This is a comforting belief that can make a person feel safer from the risk of serious illness. If it were true, you could use your mind to stop the cancer from growing. But the down side of such beliefs is that when people with cancer don’t do well, they may blame themselves.

To learn more about attitude and survival, researchers looked at the emotional well-being of more than 1,000 patients with head and neck cancer to find out whether it affected survival. Over time, those who scored high on emotional well-being showed no differences in cancer growth or length of life when compared to those with low scores. Based on what we know now about how cancer starts and grows, there is no reason to believe that emotions can cause cancer or help it grow.

Can psychotherapy help people live longer?
Research in the area of therapy, stress reduction, and cancer has come up with mixed findings. This can confuse reporters and patients alike. For example, a research study done in 1989 by David Spiegel and colleagues seemed to link a difference in survival with taking part in a support group. But other researchers who did the same kinds of studies did not have the same outcomes.

A 2004 study review pooled the results of many well-designed studies of cancer patients getting psychotherapy. With more than 1,000 patients in the final results, no effect was found on survival.

In 2007, other researchers looked at all the previous studies. They found that no randomized clinical trial set up to look at survival and psychotherapy has shown a positive effect, except in cases where medical care was a confounding factor. (This means that one group’s medical care could have been different enough to affect the results.)

Finally, Spiegel himself tried to repeat the 1989 study with a new group in 2007 to see if the result would be the same as that of their earlier trial. The 2007 study reported better quality of life among those who took part in the group, but there was no difference in survival.

In the last few decades, research has further shown that giving cancer patients information in a support group setting helps reduce tension, anxiety, and tiredness (fatigue), and may lower the risk of depression. Some other studies have shown that supporting cancer patients in keeping doctors’ appointments and teaching them about their treatment may help patients follow their treatment plan. While keeping doctors’ appointments and taking cancer treatment medicines as prescribed may help people live longer, this type of support is more medical and practical rather than mental health care.

It seems clear that support groups can affect quality of life, but the available scientific evidence does not support the idea that support groups or other forms of mental health therapy can help people with cancer live longer.