Can A Certain Diagnosis Be More Harmful Than the Disease Itself?

Did you know that the diagnosis of a common life threatening disease may be the most traumatic thing that can befall a patient, beyond the conventional treatments, many that  have life-threatening and even lethal side effects?

I recently discovered a study, published in 2012 in the New England Journal of Medicine, that helped me to understand a patient experience during my second year at Duke University School of Medicine while on my Internal Medicine clinical rotation, one patient, profoundly impacted my view of doctor-patient communications.

My Unforgettable Patient Experience

Mr. George Smith (not his real name), and his wife were equally quiet, cooperative, and extremely pleasant.  A soft-spoken man in his late sixties, he had been referred to our hospital because his local doctors could not diagnosis the cause of his symptoms. For several months he had an unusual abdominal pain and other intestinal tract symptoms.

After several days involving a variety of diagnostic tests, the unfortunate diagnosis of terminal pancreatic cancer was made. Back then, it was an untreatable death certificate. During rounds with our entire team of two physicians and two student doctors, I was in his room when our attending physician surrounded by our entire medical team gave him the news. My attending also told him he had three to six months to live.  Mr. Smith looked as though a bomb had exploded in his mind. Stunned and unable to respond, he sat before us in a stupor. He didn’t ask any questions. Mrs. Smith, standing by his side, was fully present.  An hour or so later, she stopped me in the hallway just outside her husband’s room. She grabbed my hand, looked directly into my eyes, and asked, “Is my husband going to die?”

I knew in my heart that she was searching for a ray of hope that I couldn’t provide. Her sincerity pierced my heart. I wasn’t equipped to answer the question, so I stumbled through with a response that neither comforted nor soothed her. “We’re all going to die one day. I don’t think anyone knows exactly when that’s going to happen.” I didn’t know what else to say. With that, I awkwardly escaped her grip and went about my business. Looking back on that scene, I now wonder if perhaps George’s wife had felt something in her husband’s response that caused her more concern than the doctor’s words.

After lunch, I walked past George’s room and noticed that a nurse was changing his sheets. The room was empty. I wondered where he and his wife were. I didn’t think any additional diagnostic tests were scheduled, so I asked the nurse. She replied, “George just died.”

I was stunned. I raced to the nurses’ station and asked my intern if he knew what had happened. “Seems like he had a heart attack,” he answered. “I’m not sure we’ll ever know. Considering he was terminal, an autopsy really isn’t in order.”

I believe the news of George’s diagnosis frightened him to death. I really do. There have been numerous reports of people receiving frightening news and dropping dead on the spot. The damaging changes to the brain that occur in the face of significant stress can be attributed to its adaptability to the environment. Our beliefs direct and shape our whole physiology in remarkable ways.

This week I discovered a study that confirmed what I observed.

A cancer diagnosis may be the most traumatic thing that can befall a patient within the contemporary medical system; that is, beyond the conventional cancer treatments themselves, many of which have life-threatening and even lethal side effects.

The Cancer Diagnosis

New research now indicates that a cancer diagnosis may be as fatal as the cancer itself, because it dramatically increases the risk of suicide and heart-related death in the week following diagnosis.

The aforementioned 2012 study, published in the New England Journal of Medicine,  reviewed the  data on more than 6 million Swedes aged 30 and older between 1991-2006 using the country’s health registries in order to determine how the psychological toll of cancer diagnosis impacts the risk for death.  The analysis of  over 500,000 people who were diagnosed with cancer during that period found, the risk of suicide was found to be up to 16 times higher and the risk of heart-related death 26.9 times higher during the first week following diagnosis versus those who were cancer free!

Why Are We So Afraid of Cancer?

For several decades, people have feared a diagnosis of cancer more than any other disease.  cancer has been the most feared disease. Cancer is the Big “C,” one of the scariest words you will ever hear. But why? Is it really so incurable to be paralyzed by fear? No, it is not.

We have been led to believe that cancer was a disease that is more powerful than a normal human body.  That is not true—cancer occurs only when the body is in a weakened state,  that can occur for a variety of reasons.  It is primarily a disease of lifestyle and environmental exposures.  Yes, there are inherited genes that can increase the risk of developing certain types of cancer.  Genetically occurring cancers normally cause 5% or less of all cases.

The problem with cancer has been cancer treatment, in particular chemotherapy and radiation in particular cause great harm to healthy cells while killing the cancer.  The side effects of these treatments can have a tremendous impact on the patient’s quality of life.

The Helpful and Harmful Power of Belief

Mr. Smith, I believe is the most extreme example of the harmful power fear and negative belief can have on the body.

Your beliefs are quite powerful and have a direct effect on your body’s responses. In fact, under the right conditions, your mind can heal your body in the absence of drugs or surgery. This is one of the most fascinating aspects of your body’s powerful healing ability.  Or, like Mr. Smith and others, a diagnosis can frighten you into a state of illness, far more severe than the diagnosis itself.

Your belief has a tremendous impact on your body. Perhaps the most significant example of the power of belief is the placebo effect. A placebo is an inert substance without any medicinal value, such as a sugar pill, that is given to a person who is under the false impression that it is an effective treatment. An individual’s belief alone can sometimes prompt an improvement. Placebo is Latin for “I shall please.” Thus, the placebo effect is the medical term used to describe the healing power of the mind.

Traditionally, even though the placebo effect can be measured, it is explained in a way that minimizes its true power. Among researchers, the placebo effect is presented as a nuisance, an interfering human artifact that compromises the pure approach of scientific research on active substances, such a medications and surgery.

During medical school, I learned that the placebo effect was something we “just had to live with.” It was to be tolerated, not accepted as a possibility in planning a course of treatment. However, I was absolutely fascinated by the notion that the mind was so powerful. Although most people have heard of the placebo effect, I do not think many of us appreciate the opportunity it represents.