psychoneuroimmunoendocrinology review and commentary - alternative cancer treatment

psychoneuroimmunoendocrinology is the term describing the unity of mental, neurological, hormonal and immune functions with its many potential applications. pnie addresses the influence of the cognitive images of the mind (whatever its elusive definition) on the central nervous system and consequent interactions with the endocrine and immune systems. it encompasses several arenas, including but not limited to biofeedback and voluntary controls, the impacts of thought and belief on physiology, past and present effects of stress on mental, emotional and physical function, placebo effects, cumulative effects of social relationships on health and disease, and contiguous and remote impacts of "energy medicine" on ones own function and that of others. this column highlights the impact of cogent studies from these arenas on the understanding of holistic medicine in this new millennium.

malignant melanoma and stress

james was forty-one. i had been the family doctor for his wife, an r.n., and their three girls in their growing-up years. i had seen james infrequently, however, and never for anything major. he had never been interested in a comprehensive health evaluation, and indeed, it seemed to take considerable urging by his insistent partner to be seen for anything. when i did see him, he seemed introverted, never talked much and seemed to have a mildly flattened affect as if depression might be lurking beneath the surface.

he presented at his appointment with an ominous-looking skin tumor about 8 mm in diameter on the right upper anterior chest above the nipple. he had noticed it about a month before and thought that it had grown. it was slightly raised, and faintly reddish-purple. because of the obvious malignant potential, i took the time at that appointment to excise it with a generous margin.

while injecting the local anesthetic and performing the excision, i talked with him about what was going on in his life. he related that he had lost his job about 15 months before when his employer was taken over by another company. as i worked, he described his loss of self-esteem, feelings of shame and worthlessness as his family went through a financial crisis, depending on his wife's income alone. they had spent their way through their savings and self-deprecation mounted as he failed time and again to land another job, with high anxiety over the possibility of having to take a significant cut in pay to work at all.

the pathology report in 3 days confirmed that the lesion was a clark's level 3 malignant melanoma and possessing aggressive characteristics. his wound healed well and there was no evidence that the tumor had spread into the regional axillary glands or elsewhere. as i removed his sutures a week later, he was quite upbeat, having found a job in the interval. he was scheduled to start work the following monday. i did suggest that he consult an oncologist, and later confirmed that he had declined in spite of his wife's urgings.

james, however, remained well and over the years showed no signs of recurrence. i rarely saw him, but inquired of his status numerous times on seeing his wife.

nearly ten years later, to my surprise, he presented with two hard lymph nodes in the right axilla. on biopsy they proved to be a recurrence of his malignant melanoma. i learned that about fifteen months before he had lost the job he landed at the time of my original surgery, and again had become morose, withdrawn, defeated, depressed and exhibited profound loss of self-esteem. he had discovered the lumps four months before and had done nothing about it. he refused any treatment of any kind, and died quickly about four months later. anderson r. unpublished cases. 1992 mar.

comment: one is certainly prompted to ask in such a story, "what was the melanoma doing for nearly ten years?" rationally, one must assume that there was residual tumor in the tissues for sometime. one can only conjecture that his immune system had held the tumor at bay for over nine years during which he was earning a living and felt happier and relatively good about himself. with onset of job loss, hopelessness and helplessness set in, causing the stress-related compromise of his immune defenses. i know of no other way to understand this phenomenon. many authorities deny the validity of any relationship between stress and immune resistance, and indeed a number of studies provide evidence against it. a story such as this one, however, underscores the importance of valuing our own experience. reflecting on the meaning of this clinical experience shifted my own worldview.

breast cancer and joy

in 1979, 36 women being treated at the national institutes of health for histologically proven recurrent breast cancer were enrolled; at the time of analysis in 1987, 24 had died from their malignancy. patients with the longest survivals included those who expressed more joy at baseline testing (p[less than].0001). also living longer were those who were predicted to live longer by their physicians, and quite naturally, those who had fewer metastatic sites and had had the longest disease free intervals also tended to live longer with recurrent disease than others.

levy sm et al. survival hazards analysis in survival hazards analysis in first recurrent brcast cancer patients: seven-year follow-up. psychesom med 1988 sep-oct; 50(5):520-8

comment: behavioral as well as biological factors need to be highly rated in the total care of patients with malignancies. while tumor grade, analysis of possible metastases, cellular characteristics and other biomedical factors play important prognostic roles, paying attention to the psychological, social and spiritual elements in the matrix of predictors also ranks as an essential task. some of the latter factors can be to some degree altered, improving the prognosis. brendan o'regan's collection of some 3,000 recovered cancer cases (spontaneous remission, sausalito california, institute of noetic sciences, 1993) emphasizes multiple factors which deserve attention by practitioners.

malignant melanoma, relaxation and imagery

sixty-one patients with malignant melanoma were enrolled in a study which randomly assigned them to either routine care (n=26) or a structured group intervention (n=35). the intervention group met 1.5 hours weekly for 6 weeks. group processes and interventions included health education, cancer education, enhancement of illness-related problem solving skills, instruction and practice in relaxation skills, psychological support and promoting interaction between patients and health care professionals. psychological and immunological testing was performed at baseline and at six months following the intervention. at that point, the intervention group compared to the routine group showed significant increases in large granular leucocyte cell counts (p=.038), natural killer cell counts (p[less than].006), interferon a-augmented nk cell response (p[less than].034) and overall vigor (p[less than].001). on the profile of moods scale, anxiety and depression were negatively correlated with lgl counts (p[less than].ol) an d interferon a-augmented nk cell responses (p[less than].04). anger was positively correlated with lgl counts (p[less than].002) and interferon a-augmented nk cell responses (p[less than]008). imagery enhanced effects of relaxation on t-cell counts. in six-year followup, the intervention group had a 50% lower recurrence rate compared to routine-care controls; the risk of dying from the cancer was 33% lower than the mortality rate in controls.

fawzy fi et al. a structured psychiatric intervention for cancer patients. i. changes over time in methods of coping and affective disturbance. arch gen psychiatry 1990 aug; 47(6):720-25, 729-35. j natl cancer inst 1994 feb 16; 86(4):256-58

comment: all the elements imbedded in this program have been shown to improve prognosis and enhance survival: education about health; cancer education; enhancement of illness-related problem solving skills; instruction and practice in relaxation skills and the use of imagery; psychological support with the group setting; and "psychological support" promoting interaction between patients and health care professionals. much research supports the premise that these cancer management approaches, usually thought of as "adjunctive," may be as important as the underlying biomedical treatment itself.

cancer metastases and stress

previous animal studies have shown that stress can increase tumor development including accelerating initiation, growth, and metastases; and can decrease antibody formation, interferon synthesis, mitogen-stimulated lymphocyte proliferation and nk cell cytotoxicity. nk cells are particularly important in controlling tumors. in several studies, the way people cope with stress has been correlated with cancer-related deaths and rate of tumor progression. a fixed number of mammary adenocarcinoma cells was injected into rats who were then randomized to a control group remaining in their cages or to a group stressed by having a weight attached to their tails and left in water for five 3-minute sessions interrupted by 3-minute rest periods. twelve days later, the number of pleural surface metastases was counted. stressed animals had twice as many metastases as controls (p[less than].0l). splenic nk cell cytotoxicity from stressed animals was suppressed 45% in stressed animals compared to controls (p[less than]0l). in animals stressed one hour before tumor cell injection, there was a 5-fold increase in metastases over controls (p[less than]01). acth and corticosterone levels one hour after the stress experience were 2-fold higher in stressed animals v. controls (p[less than]01).

bea-eliyahu s et al. stress increases metastatic spread of a mammary tumor in rats: evidence for mediation by the immune system. brain behav immun 1991 jun; 5(2):193-205

comment: this is an animal study. conclusions may not be totally applicable to human situations, but appear to often permit understanding of mechanisms involved in disease. unmanageable stress favors lower nk activity and metastatic spread of carcinoma. some human studies which i have previously discussed in this column also tend to corroborate the correlation of stress with higher risk of metastases. the hypothalamic-pituitary-adrenal axis shifts in hormones monitored in this study provides the best plausible evidence for postulating the mechanism involved.

lung cancer and psychosocial disruption

a population based case-control study involving 750,000 chinese included 309 lung cancer cases and 1,231 matched controls. three of six psychosocial factors were positively associated with lung cancer: 1) "uncontrollable bursts of emotion" (odds ratio for cancer 1.8, p[less than].01); 2) "poor working circumstances" including poor relationship with colleagues (or 1.4, p[less than].05) and superiors (or 1.6 p[less than].01); and 3) long term depression (or 4.1, p[less than].0l). long standing depression (8.8% of the population) as a risk factor for lung cancer led to an attributable risk for lung cancer of 21.6% (men 18.7%, women 26.4%).

fan rl et al. study on the relationship between lung cancer at preclinic stage and psycho-social factor. a case-control study. chung hun liu hsing ping hsueh tsa chih 1997 oct; 15(5):289-92

comment: this is a chinese study which provides evidence for a high degree of correlation of psychosocial factors and preclinical lung cancer. the third factor, depression, has been suggested as a strong factor in many other studies. questions by practitioners about psychosocial issues are the first step in eliciting information which provides the basis for a plan to deal with these factors. too often, the rule about psychosocial factors in practitioner-patient relationships is "don't ask, don't tell." holistic primary care takes a long step past that barrier.

lymphosarcoma, beliefs, and placebo

this is a case history of a patient with advanced terminal cancer who, having received all the conventional cancer treatment offered, was given a prognosis of less than a month to live. he went to a cancer clinic in texas, where he was found to have severe anemia, metastatic subcutaneous tumors over much of his body, and bilateral pleural effusions. as part of a trial of krebiozen, a new highly touted cancer cure, the drug was given to him because he begged for it. he had great hopes for benefit even though the late stage of his advanced cancer made him truly ineligible for treatment. two days after his first injection his tumors had shrunk to 1/2 of their former size and his pleural effusions were gone. he was given three injections a week and was discharged. after two months of excellent health, on reading conflicting reports about the efficacy of the drug, he relapsed to his former pre-terminal state. his physicians at the clinic offered him injections of a new "double-strength, super-refined batch" of kre biozen which was actually a placebo. he again improved with regression of tumor masses and disappearance of chest fluid. he remained symptom-free until two months later when he read the final ama report that krebiozen was useless. he precipitously declined and died two days later.

klopfer b. psychological variables in human cancer. j projective techniques pers assess 1957 dec; 21(4):331-40

comment: this widely-quoted report underscores the importance of hope and beliefs. the placebo effect, a recent report notwithstanding, is alive and well, supported by thousands of studies over the last 60 years. there are few psychoneuroimmunological studies more powerful than those demonstrating the effects of mind, including beliefs, on biomedical outcomes. there is also strong evidence that beliefs can be altered in ways that improve outcomes.

cancer and social support

in a population-based sample of 525 black and 486 white women with newly diagnosed breast cancer, there was little or no evidence for an association between individual network measures of social ties and stage of disease. however, a summary measure of social networks was found to be associated modestly with late stage disease, attributable in part to significantly more advanced disease among black, but not white, women reporting few friends and relatives (rr = 1.8; 95% ci 1.1-3.0). with adjustments for differences in stage of disease and other covariates, the absence of close ties and perceived sources of emotional support were associated significantly with an increased breast cancer death rate. the relative risk of dying from breast cancer for white women in the lowest quartile of reported close friends and relatives was 2.1 v. white women in the highest quartile (95% ci = 1.1-4.4). notably, both black and white women reporting few sources of emotional support had a higher death rate from their disease duri ng the 5-year period of follow-up (rr 1.8; 95% ci = 1.3-2.5).

reynolds p et al. the relationship between social ties and survival among black and white breast cancer patients. national cancer institute black/white cancer survival study group. cancer epidemiol biomarkers prev 1994 apr may; 3(3):253-9

comment: social isolation has a statistically devastating effect on the prognosis of numerous serious disease processes, including the course of cancer. "social medicine" is a topic which should be emphasized in all schools of healing. while practitioners control neither the social decisions nor patient impulses to establish close relationships, they do have the opportunity to talk about these factors, and encourage their development. one practical way this can be developed is through group participation organized by the practitioner him- or herself, or by using excellent referral resources for incorporating the benefit of support and educational opportunities.

breast cancer and support groups

sixty-six patients with metastatic breast cancer were randomized to routine treatment (n=36 controls) or to an 8-month, weekly psychological intervention (n=30). subjects were assessed at baseline, 4, 8 and 14 months for mood, quality of life and adjustment to cancer. results demonstrated little psychometric difference between the control and intervention groups, in spite of the fact that when the intervention subjects attended a weekend of support and training in coping skills, the usual significant, short-term changes were observed. in the long-term intervention, subjects did experience more anxious preoccupation and less helplessness than the controls but no recorded improvements in mood or quality of life. however, profound clinical changes were observed by the therapists, similar to those noted by spiegel et al. (1981). the authors conclude that many of the psychological changes made by subjects in long-term interventions may elude conventional psychometric assessment.

edmonds cv et al. psychological response to long-term group therapy: a randomized trial with metastatic breast cancer patients. psychooncology 1999 janfeb; 8(1):74-91

comment: further research, of a rigorous qualitative nature, is required to develop a clearer understanding of the experience of living and eventually dying of cancer within the context of a long-term intervention. while practitioners wait for that data, vigorous application of the principles tentatively pinpointed by research to date should be pursued. these include the importance of emotional and attitude positivity including hope, imagery, relaxation practice, positive beliefs, social involvement and support, emotional closeness in relationships, and overall life optimism.

neuroblastoma and healing

this is the case history of a 12 year-old girl from sicily who presented with a painful right knee. x-rays demonstrated bony change and a biopsy showed neuroblastoma. surgical amputation was advised and refused. cobalt radiation was arranged but the girl was so unhappy in the hospital her parents took her home before the first treatment. a decision was made to make the trip to lourdes, france, which took place in august 1976. she spent four days attending the ceremonies, bathing in the water and praying at the grotto. she did not improve and returned home where x-rays showed tumor extension. her mother prepared for her death, although villagers continued to pray for her and her mother continued to give her lourdes water. shortly before christmas, weighing 22 kg, she suddenly asked to go outside and her knee swelling soon afterward disappeared, leaving her with a slight genu valgum deformity. her health returned to normal. repeat x-rays showed bony repair. in 1982 her case was accepted by the lourdes committe e as "inexplicable" and placed in the registry of miraculous cures.

dowling sj. lourdes cures and their medical assessment. j r soc med 1984 aug; 77(8):634-38

comment: "miraculous" healings are probably much more common than most authorities realize or admit. the reason is that editors frequently reject such case histories as hoaxes or lacking credibility. the o'regan summary of 3,000 cases of "spontaneous" recovery contains many stories which carry the thread of abrupt shifts undertaken by cancer patients: shifts in nutrition, attitude, belief, exercise, intention, and acceptance. most of the "miraculous" cures of cancer which i have encountered have not been published. they are only circulated by word of mouth. an enterprising doctoral thesis for an energetic student somewhere would be to circulate a request that practitioners report their well-documented experiences of healing of advanced cancer and publish these as a compilation of such case histories. i believe there are many thousands of such cases to be reported.

robert anderson is a retired family physician. in mid-career, his practice took on a more holistic nature as decades passed. he has authored five major books, stress power! (1978), wellness medicine (1987), the complete self care guide to holistic medicine (1999) (co-author), the scientific basis for holistic medicine, (5th edition) available from american health press, nhf@satnetcomputers.com This e-mail address is being protected from spam bots, you need JavaScript enabled to view it , and clinician's guide to holistic medicine (mcgraw hill, 2001). anderson is serving as the founding president of the american board of holistic medicine, is a past president of the american holistic medical association, former assistant clinical professor of family medicine at the university of washington, and currently adjunct instructor in family medicine at bastyr university.

copyright 2001 the townsend letter group
copyright 2001 gale group

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