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Stress and Breast Cancer: An Educational Forum with Dr. David Spiegel

by Suzan Berns

September 26, 2005

Support groups and other means of reducing stress in women with breast cancer may not result in living longer, but they will clearly result in living better, said Dr. David Spiegel, Medical Director at the Center for Integrative Medicine at Stanford Medical Center.

Spiegel shared the results of his research on the effects of stress on women with metastatic breast cancer with an audience of 100 at a public forum sponsored by Zero Breast Cancer and the Breast Health Center of Marin General Hospital on Monday, Sept. 26 at the Marin Civic Center. Earlier, he met with a dozen researchers and health professionals at the Marin JCC for an update and question and answer session.

Spiegel assured the audience - more than half who were breast cancer survivors according to an informal show of hands - that breast cancer is not caused by stress, nor can one cause it to occur. “It’s a biological event . . . it’s happening in your body. Don’t blame yourself,” he stated.

He called the belief that one can will away disease with an upbeat attitude the “prison of positive thinking.” Studies indicate that people who deny their negative feelings are in fact less successful in fighting cancer, he said. “If there’s anything I’m sure of after 30 years of work in this field, it’s that you have to face things.”

Spiegel recently analyzed data collected on stress levels from 600 Marin women—300 who had breast cancer and 300 who did not. The study, Breast Cancer and Psychosocial Factors: Early Stressful Life Events, Social Support and Well Being measured the sense of well-being of the participants. Spiegel found that those with a stressful childhood and breast cancer reported more well-being than those with a similar life history but without. Those without, he noted, were able to discuss stress-related conditions in their lives, whereas the women with breast cancer were more likely to gloss over it.

Spiegel, who began studying women with breast cancer and support groups nearly 30 years ago, said that the connection and interaction among participants in a well run group helps them look realistically at their situation, enables them to cope with fears, provides tools for dealing with illness, and offers a social forum where they can feel comfortable talking about cancer and expressing emotions.

Initially, he was worried that support groups might be demoralizing for the participants, Spiegel recalled. He was concerned that intimate connections with others who were depressed, whose cancers had returned or who had died would create more negatives than positives. Instead, he said, “I’m convinced we help, we don’t demoralize.”

Facing the possibility of death, he said, is far better than hiding from it, for it enables you to deal with it. Stress is compounded by helplessness. Not facing fears results in immobilization and then more of a sense of being out of control, and possibly depression. And, he noted, there is some evidence that depression is associated with more rapid cancer progression.

When a group member dies, Spiegel said, “It’s the business of the group to reach out to the others.” Spiegel described a group with a member who died unexpectedly, shortly after joining the group. The participants felt abandoned, a common reaction, he noted, as well as a mix of other feelings. Some felt they hadn’t had time to get to know her; others wanted to say goodbye; and in general, they were distressed about the lack of predictability.

Noting that we live in a death-phobic culture in which each of us deals with dying alone, he explained that one of the roles of a support group is to detoxify dying by restructuring the "overwhelming fear" into parts and providing coping strategies for each. The parts include the process of dying; separating from loved ones; loss of control; and pain. “You can’t do anything about dying, but you can do something about how you do it,” he said.

Spiegel said that even in today’s society, where breast cancer is presumably discussed openly, those who have it feel isolated and guilty. In addition, it’s a deep assault on their sense of self-knowledge. “It comes out of the blue . . . their body has betrayed them,” he explains.

The worse time for women with breast cancer is when it is diagnosed, but the second worse is when treatment ends. “Suddenly you’re not doing anything, except waiting for the other shoe to drop,” he explains. He called it “living with the cloud,” a situation he described for most women in remission.

Support groups meet weekly for 1.5 hours, building bonds and social networks, an essential need for humans, he commented. They provide opportunities to express emotions and systems for looking at reordering life priorities.

Spiegel synthesized it in the acronym FACES: Facing it rather than fleeing; Altering perceptions; Coping actively; Expressing Emotion; and Social Support.

While stress can’t cause breast cancer, it can “hijack your mind and state of being,” Spiegel said, by affecting endocrine activation, circadian rhythms, and immune defenses. Normally cortisol levels are highest in the morning, but in breast cancer patients they vary throughout the day. This can result in sleep deprivation, and subsequently lower levels of the anti-oxidant hormone melatonin, and impaired stress response.

“The message,” he said, “is that you should take care of yourself—do what you can to get a good night sleep.”

Spiegel is the author of the landmark study Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer. He began his study of breast cancer and support groups in 1976 and opened the Center for Integrative Medicine in 1998. His work has been featured on Bill Moyer’s Emmy Award-winning special “Healing and the Mind.” He has published numerous studies on the positive effects of group psychotherapeutic intervention on mood, coping and pain and is the author of the book Living Beyond Limits.

Spiegel noted that while his research is less conventional, it is done with "the same rigor" as any scientific study. In the future, the center will increase its capabilities of supporting women with breast cancer by taking advantage of the internet and other technological advances, which he noted, are "surprisingly effective." In addition, the Center plans to study changes in hormone levels in response to stress.

The forum, one of several offered each year by Zero Breast Cancer, was made possible by funds received from the Andrea Fox Fund, established by the Marin County Board of Supervisors and administered through the Marin County Department of Health and Human Services.

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