Attitude and disposition: Do they make a difference in cancer survival?

Psychosocial and spiritual factors influence a broad spectrum of medical and surgical disorders. The adverse effects of stress have been most clearly documented in cardiovascular disease. In cancer, unresolved questions include the following: Do emotional factors have a causal role in either initiating or promoting a malignant process, and can they possibly accelerate the dissemination of cancer? The literature, which consists of anecdotes, case-control methods, and randomized trials, is inconsistent and beset with major methodologic problems. Psychosocial interventions can be life enhancing in sharp contrast to the guilt-ridden programs of some alternative practitioners. A social support system and an element of spirituality and religion seem to be the most consistent predictors of quality of life and possible survival among patients with advanced malignant disease.