Positive Thinking Is Powerful During and After Cancer Treatment

CURE, CURE® Spring 2021 Issue,

Channeling optimism during your cancer journey isn’t just about living longer — it’s about living better.

In the fall of 2018, Teri Cettina began feeling a mysterious pain around her ribs. “I thought I had done too many ab exercises at the gym,” says the 55-year-old health writer from Portland, Oregon.

When Cettina visited her doctor, her blood and urine tests came back normal. But over the next several weeks, the pain worsened. Convinced her muscles were out of whack, she saw a physical therapist who did a 10-minute exam and told Cettina, “This is not musculoskeletal; it’s not a rib thing. It’s deeper — you need to see your doctor today.”

Later that day, Cettina had a CT scan and received a diagnosis: pancreatic adenocarcinoma. Cettina’s tumor was particularly troubling because it was entangled in her veins and branches of the aortic artery, making surgical removal virtually impossible. Such grim news would send even the most hopeful optimist into a tailspin.

Cancer and depression are biochemically linked, which complicates patients’ ability to stay positive. “Something about the development of the cancer leads to a chemical imbalance in the brain that manifests as depression,” says Dr. Allyson Ocean, associate professor of medicine at Weill Cornell Medical College in New York City. Left untreated, depression can interfere with patients’ ability to fight the disease.

“Depression is a deactivating condition, meaning you tend not to do things,” says Dr. William Dale, the Arthur M. Coppola Family Chair in Supportive Care at City of Hope Comprehensive Cancer Center in Duarte, California. “If you’re depressed, you’re more likely to skip an appointment or miss a medication and less likely to eat well, exercise and spend time with people who make you feel good.”

Despite tough odds and toxic treatments, people do survive pancreatic adenocarcinoma. “There may be a single digit survival rate for this diagnosis, but that means at least one person survived,” Cettina says. “I just keep saying to myself, ‘What one person can do, another person can do.’”

Studies about whether optimism such as Cettina’s improves cancer outcomes are largely inconclusive. It’s not clear whether a glass-half-full mentality can help patients with cancer live longer. What scientists do know is that there are plenty of perks to positive thinking — some of which have nothing to do with survival rates.

Find Your People

Ever notice how your mood changes when you see someone you love? Positive friends support you when you need it, stick around when you want to discuss the hard stuff and bring out the best in you just by showing up. Turns out those same qualities are key when putting together your health care team.

“I learned early on that you need doctors who are willing to fight for you, who believe you can beat the disease,” Cettina explains. “My first potential surgeon looked at me with sad eyes and told me I was going to get really sick very quickly and statistically had about 18 months to live.”

A week later, Cettina met with a different oncologist for the first time. He didn’t have great bedside manner. But he was logical, even hopeful, about Cettina’s odds. He told her, “There’s a 25% chance your cancer will respond to treatment to make surgical removal possible. That means 25 out of 100 people go through this treatment and come out of it. Why couldn’t one of those four people be you?” Cettina knew she had found the right oncologist.

No matter your type of cancer or its stage, the messages you receive are critical, says Ocean, who co-founded Let’s Win!, an innovative nonprofit dedicated to advancing pancreatic cancer research. “Our goal is to connect patients to the researchers, doctors and survivors who can give them reason to hope — not just because there is reason to hope, but because having a positive attitude enables patients to fight the disease in a stronger way.”

While there are no data to suggest that staying on the sunny side improves outcomes, there’s no doubt that if you have hope, you’re more motivated to try complementary treatments, ask questions and get second opinions. You’re also more likely to advocate for yourself. For Cettina, that meant telling her health care team that she didn’t want to hear about potential time frames or poor survival rates unless she specifically asked. She wanted to hear about pancreatic cancer survivors.

“I knew how bad the prognosis was because I’m a health writer,” Cettina says. “So, I skimmed over the scary statistics and focused on researching hopeful stories about survivors. That became my coping mechanism.” She found her first pancreatic cancer survivor on The University of Texas MD Anderson Cancer Center website, a middle-aged woman with stage 4 disease, just like Cettina. After the two connected via email and then phone, Cettina set out to find more survivors and learn everything she could about how they were beating the disease.

“Connecting with survivors is important,” Ocean says. “They can give you tips based on their experience, direct you to clinical trials and help you formulate questions for your physicians that you may not have thought to ask.”

In addition to assembling a team of experts who believe you can beat the disease and survivors who prove it can be done, it’s important to convene support closer to home. After receiving her diagnosis, Cettina knew she needed more people in her corner.

“I hadn’t been a big Facebook user, but I felt strongly that sharing this scary news with my network would somehow be helpful,” Cettina says. “The response was incredible. Just reading positive words from friends and loved ones made me feel better.” The outpouring of support — even from unexpected places — helped buoy her as she navigated rough waters.

Build Resilience

In 1990, when Lonnie Reed was 40 years old, doctors gave her a breast cancer diagnosis. She elected to have a lumpectomy followed by radiation, and doctors followed her for several years before declaring her “cleared.”

But 17 years later, the broadcast journalist turned state representative from Branford, Connecticut, noticed hypersensitivity in the same breast when she was snorkeling through a school of blue tang in the Cayman Islands. The cancer was back.

“This second primary made me angry and depressed. I had worked so hard to live a healthy life. I felt betrayed,” Reed says. “The doctors said they had to do a mastectomy. I told them to take them both because my breasts were trying to kill me.”

Reed’s cancer was triple negative, which required a long course of chemotherapy. During treatment, she began re-evaluating her life. ”I discovered I didn’t have time or energy for people and activities that didn’t fill my cup,” Reed notes. She created a chart with two columns. In column A, she listed things that made her feel calm and happy. In column B, she listed the things that made her anxious or sad. Then she began the difficult work of pruning.

“Your time and energy have to be spent carefully when you have a serious illness (such as) cancer,” Dale says. “Patients and families can get stuck thinking about what happened six months ago or questioning how a doctor missed a mass on a mammogram. Unfortunately, we can’t change what happened a year ago, but we can do something right now that will make a difference. We can help people grab on to positive experiences and enjoy the life they have right now.”

Working with a therapist can help you not only cultivate gratitude but also challenge negative thought patterns. “I learned to ask myself: ‘Do you have proof that a certain bad thing is going to happen?’ If I don’t have proof, the next question is, ‘How do you feel when you believe this sad story?’” Cettina says. The idea is to recognize that these negative thought loops don’t serve you. Sometimes that requires getting out of your head and finding a purpose bigger than beating cancer.

Forge new relationships, join a cause that’s important to you or take a bucket-list trip that you’ve postponed. ”Just don’t stop having positive experiences because you’re sick,” Dale says. For Reed, that meant focusing her energy on environmental threats. Using her high-powered social connections in the media and political worlds, Reed not only fought to stop a dangerous gas plant project while undergoing chemotherapy treatment for her second bout of breast cancer, but she also ran for office.

“I had all of these people looking to me for leadership. That was really encouraging and made me feel present and empowered,” she says. “It gave me purpose and with the support of a team of amazing people, we killed the plant proposed for Long Island Sound. I thought, if I can defeat a giant floating gas plant, I can defeat cancer.”

After her last chemotherapy treatment, Reed traveled to Paris with her partner. When she returned from the trip, politicians from both sides of the aisle convinced her to run for a seat in the Connecticut House of Representatives — a seat she won in 2008.

Cultivate Healing

The idea that you need to stay positive to effectively treat cancer can put a lot of pressure on an already overtaxed psyche. Amidst the barrage of “stay strong,” and “you’ve got this,” you may feel as though you need to hide your shock, pain, anger and grief from friends and family, and that takes a lot of energy.

“As a culture, we want to believe we can think ourselves out of cancer, that we can cause the cancer cells to go away,” says Dr. Jana Bolduan Lomax, a licensed clinical health psychologist in Denver who specializes in coping with cancer and survivorship. “The reality is, we don’t have that control, but we can create space for people to feel safe to be mad and angry, even if it’s inconsistent with their identities.”

People with late-stage disease often perform a delicate dance of trying to show people in their lives they’re strong while also trying to prepare themselves for their death.

The best way to address both the desire to live and the desire to let go: Get palliative care (also termed supportive care) involved.

“People think when you have palliative care on board that you’re giving up hope,” Lomax says. “That’s not the case at all. Instead, palliative care allows for better symptom management and enhanced quality of life.” Research also suggests it may help you live longer.

Results from a study published in Health Psychology in 2017 demonstrated that patients with advanced cancer who were depressed and who received palliative care interventions lived longer than those who did not get palliative care services. Researchers suspect that palliative care not only plays a role in managing symptoms but also helps patients focus on what’s most important to them: Finding joy despite a difficult diagnosis.

“Cancer takes up a huge slice of the pie. How can you reclaim some of the other slices of that pie?” Lomax says. For Reed, that meant laughter and music. She regularly indulged in all-out cancer laugh fests with her friends and created playlists of her favorite songs: Aretha Franklin’s version of “Bridge Over Troubled Water,” The Beatles’ “Here Comes the Sun” and Bette Midler’s “The Rose.” “‘The Rose’ always made cry tears of hope, and I would end these customized concerts with Helen Reddy’s ‘I am Woman,’” she says.

Cettina’s not-so-guilty pleasure is Netflix, especially shows such as “Outlander” and “Bridgerton.”

“Watching period pieces takes me out of my life for a while,” she says. She also regularly takes time out to tune into her body with qi gong classes, sound (and water) baths and journeys through the art of guided imagery, meditation and hypnosis. Although her goal with hypnosis was initially to alleviate the anticipatory nausea she experienced prior to chemotherapy, the therapist also harnessed the power of her mind to tackle big picture issues.

“He said things (such as) ‘Your body is a healing machine,’ ‘Your body wants to return to its healthy state,’ and ‘You’re going to surprise your doctors and cure this pancreatic cancer,’” Cettina says. “I didn’t believe his words in the beginning, but I listened to them over and over, borrowing his optimism.”

Six months after Cettina’s diagnosis, her tumor had shrunk significantly. However, the presence of liver lesions meant she was not eligible for potentially curative surgery. Long-term survival felt impossible. “I really felt smashed at that point. I curled up into a ball for a few days and felt really bad,” she says. But when Cettina emerged, she uncovered other treatment options she wouldn’t have pursued if she had been eligible for surgery.

“I think people’s mindset needs to be that they’re not dying of cancer. They’re living with cancer,” Ocean says. “To live a life of happiness and positivity is like medicine, and I do think it can help change the trajectory of the disease, even if it’s only a temporary change.”

With cancer, doors will close. When they do, the key is to look for a proverbial window. Cettina already has outlived her initial life expectancy. “I already feel (as though) I’ve won the cancer lottery,” she says. “I can’t say for certain whether my optimism has kept me going, but it has taught me that good things can come from a bad situation. I’ve been lucky before. I could be again.”

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