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The Perspective of a Physician with Advanced Cancer
on January 27, 2009
Five years ago I was diagnosed at the age of 46 with Stage IV colon cancer. What a shock! While receiving treatment (surgery and chemo), I read the medical literature on the subject, so I could understand the evidence behind the various treatment options. I also read this book as well. As I read Dr. Segal's book, I was impressed, and moved, by the author's approach. Indeed, I was so impressed that I looked into joining one of his "exceptional cancer patient" (ECaP) groups.
Still, I was concerned that the evidence presented in the book, while heart warming and convincing sounding, was purely anecdotal. Had any proper studies on his methods been carried out and published? Somewhat to my surprise, I found the following article: Gellert GA, Maxwell RM, Seigel BS: "Survival of breast cancer patients receiving adjucntive psychological support therapy: a 10-yr follow-up study." J Clin Oncol 1993; 11:66-69. In this study thirty-four women with breast cancer attending the ECaP program were matched with comparable patients (age, stage of cancer, etc.) from tumor registries. At ten years, there were no differences between the groups in terms of survival (approximately 40% alive at the end of the study).
How disappointing! I have read that Bernie Segal dismissed the study's methods, and hence its results. My reaction to that is twofold. First of all, as he was one of the principal authors of the study, he had control over the study's methods. It seems disingenuous to criticize its methods after its completion, given its negative results, especially when he had control over the design of the study. Would he have found its methods acceptable had it shown positive results? Secondly, even if the study's methods were less than ideal (A larger number of patients in the study would have been preferable.), why has he not restudied the matter during the last fifteen years? My guess is that he lacks confidence that a second study would produce more positive results. What other explanation can there be? In summary, I find the results of this study, combined with the lack of a repeated study by Dr. Segal, absolutely damning with regards to Dr. Segal's theories and methods. Anecdotal evidence, which is what is presented in the book, since it can be chosen selectively and distorted, is no evidence at all.
Somewhat disturbed by the above research, I read what other studies that I could find on psychological adjunctive treatments for cancer. Based upon Dr. Segal's, and others', books, it has become conventional wisdom that a positive attitude improves one's survival duration and odds. Sadly, it appears that the evidence (1: Cunningham et al Psychooncology 1998: 7:508-517; 2: Goodwin et al; NE J of Med; 2001; 345:1719-1726; and others) does not support this theory.
Regarding my personal case, while I have not persued psychological methods (those espoused by Dr. Segal or those promoted by others) in dealing with my cancer, I have done extremely well. Thanks to chemotherapy and the quality care by my physicians and nurses, more than five years after the diagnosis, I am still alive. While the cancer has progressed, and I am not expected to live another year with it, I cannot complain about how well I have done: only 2-3% of colon cancer patients with cancer stage IV disease on the best available chemotherapy survive so long. Indeed, had I enrolled in one of Dr. Segal's "exceptional cancer patient" groups, or even had I privately battled cancer with the methods that he describes, then my case might be touted as proof of the validity of his methods. So much for anecdotal evidence!
In summary, I find that the book promotes disproven ideas.