Positive psychological well-being is not the same as the absence of psychological distress. That's a key argument a group of psychological oncology and psychiatry researchers have made in the Journal of Clinical Oncology (2022; doi: 10.1200/JCO.21.02507). It's important because positive psychological well-being, measured by indicators like positive affect, gratitude, optimism, and life purpose, generally tends to be linked to improved morbidity and mortality. The researchers suggest that, when it comes to managing mental and emotional health for cancer patients, paying more attention to these positive psychology measures and developing interventions to improve them may improve quality of life and outcomes.
"Having a cancer diagnosis can be challenging," said Hermioni L. Amonoo, MD, MPP, the Carol C. Nadelson Distinguished Chair in Psychiatry at Brigham and Women's Hospital and Assistant Professor of Psychiatry at Harvard Medical School. "A lot of focus on well-being in this population has been pertained to taking away the stress, which is really important. But we've also found there are other aspects of well-being, positive psychological well-being, which has not been studied extensively in oncological populations, but are pertinent to the lived experience of having cancer." Enhancing the positive psychological aspects of well-being is different from taking away the stress, she told Oncology Times. It's about enhancing positive thoughts and resilience. They're related, of course. But Amonoo explained that focusing solely on eliminating anxiety or depression doesn't mean someone necessarily feels happiness, gratitude, and hope. She shared her thoughts on how this area of research applies to patients with cancer and potential outcomes.
1 How are these positive psychology constructs related to cancer outcomes?
"Positive psychological well-being constructs, such as optimism and its links with clinical outcomes, have been extensively studied in patients with other chronic diseases. If you look in the cardiovascular literature, there's very clear evidence that positive psychological well-being is associated with important clinical outcomes, including better quality of life and less cardiovascular mortality. Specifically looking at optimism, there's evidence that having more of it is associated with less stroke mortality, less cardiovascular mortality, and in some cases, better quality of life.
"One potential mechanism underlying these associations between positive constructs and clinical outcomes in patients with chronic diseases is behavioral. We know that patients who have high levels of positive psychological well-being constructs are more likely to engage in healthy behaviors, such more physical activity, treatment adherence, and smoking cessation. They are also more likely to make better dietary choices. All of these health behaviors have well-established links to better clinical outcomes.
"The evidence is not so vast in oncology populations. Some of our work has tried to characterize this. In a systematic review to determine the association of positive psychological constructs and outcomes in patients with hematologic malignancies who have undergone stem cell transplantation, we found that optimism and positive affect were associated with improved quality of life (Biol Blood Marrow Transplant 2019; doi: 10.1016/j.bbmt.2018.09.030).
"Other initial qualitative studies have shown that, even in the midst of a cancer diagnosis and intensive treatment, patients do experience these positive emotions (Psyco-Oncol 2019;28:1633-1639). Our current work is trying to establish how interventions that increase these positive psychological well-being constructs are feasible and could potentially impact clinical outcomes in vulnerable oncological populations."
2 What research would you like to see?
"Our research program aims to shed light on how these positive psychological well-being constructs play a role in the lived experience of patients with cancer in the short and long term. It would be great to characterize the variety of positive constructs people with cancer experience at pretty much every stage of the cancer cycle. So when someone is first diagnosed, what positive constructs are they having versus during acute cancer treatment or when they are in remission or even at end of life?
"Also, we need to develop more interventions. For those of us who work on supportive oncology interventions, we know that one resource does not fit all. Our goal is to have a toolbox of different resources for different patients. Patients all differ. Oncologic disease is different. Treatment is different. The goal is to have a plethora of resources for as diverse a group of patients as possible so that, when someone enters the cancer cycle, they would have options to choose from to help with improving positive well-being. We also need to assess the impact. How do you assess the impact of these positive constructs in a meaningful way in an oncology population? Developing tools to also assess where patients are in a longitudinal way would also be useful."
3 What's your bottom-line message?
"People should keep an eye out for this. I think patients also want their clinicians to be curious about the aspects of their experience navigating cancer and treatment. We provide some guidance in the article as to how clinicians could use simple questions to explore where patients are when it comes to their positive psychological well-being. So, for the average clinician, to keep as part of their mental health check-in for patients: ask patients, what are you grateful for? What matters to you in terms of purpose? What are your goals in terms of treatment? Are you satisfied? Using very simple questions to be curious about where patients are when it comes to these positive constructs could potentially impact how much clinicians learn about their patients, and how much patients feel seen and heard by their clinicians. Understand where patients are when it comes to making different decisions at different stages in their care."