December 9, 2005
Fighting Cancer May Mean Fighting ‘Fate’
A belief that illness is 'meant to be' can prove deadly, experts say
A cancer diagnosis can present the average person with the battle of his or her life. But new research suggests too many may be giving up on that fight far too early.
One example: In a recent effort to recruit high-risk black and Hispanic New Yorkers to a breast cancer prevention drug trial, researchers at Columbia University asked each potential candidate whether or not she agreed with the statement, "If someone is meant to get cancer, they will."
Nearly one out of three (30 percent) of the women who declined to join in the trial said they agreed with that statement -- that it was pointless to try and ward off breast cancer, even when they knew their odds for the disease were high due to a family history.
Even among women who agreed to join the trial (which will compare the effectiveness of tamoxifen vs. raloxifene in preventing breast malignancy), 11 percent said they believed getting cancer was simply a matter of fate.
Fatalism can undermine the care of patients newly diagnosed with cancer, as well, experts say.
"When you see people they'll say, 'My sister died, and she got all this treatment, why should I go through all that?' Even though the patient may have an earlier stage of cancer, and we've advanced in science [since then]," said Dr. Dawn Hershman, co-director of the Breast Program at the Herbert Irving Comprehensive Cancer Center, part of Columbia's Medical Center in New York City.
Hershman and other experts from Columbia and the National Cancer Institute spoke at a recent NCI-sponsored briefing in New York City on racial disparities in cancer prevention and care.
Even though the briefing focused on racial disparities, the experts agreed that fatalism cuts across racial lines, and is more closely linked to education and low socioeconomic status.
"We know that in Appalachia, for example, poor whites also have a high propensity toward fatalism," said Dr. Harold P. Freeman, former director of the NCI's Center to Reduce Cancer Health Disparities and currently medical director of the Ralph Lauren Center for Cancer Care and Prevention in New York City.
"In Harlem, where I work, there's a lot of fatalism as well, but I believe it's more related to poverty and a lack of education," Freeman said.
A religious belief that God or some "higher power" is ultimately in control of one's health can also spur apathy about cancer prevention, detection and care. But Hershman, who is also an assistant professor of medicine at Columbia's medical school, said she's seen religion empower patients, too.
"Sometimes those beliefs can guide people to do more, to want to be around for their family and to experience things in life," she said. "Or, sometimes those beliefs can be destructive -- they end up saying, 'No matter what I do, nothing is going to matter anyway.'"
Fatalism can often cause patients in already underserved communities to decline potentially lifesaving treatments. For example, Hershman pointed to one recent study that found that, compared with whites, black patients diagnosed with esophageal cancer are less likely to consult a surgeon (70 percent for blacks vs. 78 percent for whites), and much less likely to undergo surgery (35 percent for blacks vs. 59 percent for whites).
Poorer, non-white patients are also much more likely to miss out on chemotherapy than more affluent whites, and black breast cancer survivors have higher dropout rates than whites when it comes to taking the drug tamoxifen, which has been proven to lower breast cancer recurrence.
Distrust of the medical system can bolster fatalistic attitudes, as well. The infamous Tuskegee syphilis trials of the last century -- where infected black men were intentionally left untreated by white doctors -- have raised suspicions among the black community, the speakers said.
"If you distrust your physician and they're going to give you a treatment that might make you sick, it's a lot easier to think that that treatment isn't going to be helpful anyway," Hershman said. "You just choose not to believe what they are saying."
How to fight these types of beliefs? Institutions like Columbia and their affiliated hospitals have begun to use new outreach programs such as patient "navigators," where a newly diagnosed patient is guided through the cancer-care process by a volunteer cancer survivor -- preferably from his or her own racial and cultural background.
"One of the great things about the navigator programs is that you can enlist a group of women who have had breast cancer, and they can 'sister off' with women who have just been diagnosed. They'll say 'Hey, I've had a lumpectomy, I've had radiation and chemotherapy.' And, yes, it was pretty crummy at times, but I'm OK,'" said Columbia professor of medicine Dr. Victor Grann, an oncologist who is also director of health outcomes research at the university's Herbert Irving Comprehensive Cancer Center.
Grann is currently helping to set up the NCI's tamoxifen-vs.-raloxifene STAR trial, where minority women with a previous family history of breast cancer will be asked to take either one of the drugs over five years to help prevent breast malignancy.
In essence, by joining the study, these volunteers are thumbing their noses at fate.
Speaking through an interpreter, 53-year-old Latina trial participant Gloria Joa of the Bronx said she's optimistic, not fatalistic.
"I'm getting the treatment now, and I'm very positive that I'm going to stay well," she said. "I know that I don't have breast cancer, but that maybe in the future there's a chance that I will. But I'll fight anyway."
For more on cancer prevention, detection, and treatment, visit the National Cancer Institute (www.cancer.gov ).