Betsy Bates Freed, PsyD

If you want to understand how well human beings perceive risk, just stand in line at the gas station when lottery tickets are all the rage, or spend an hour or two loitering at the quarter slots in Las Vegas.

We humans aren’t very swift at calculating the odds of becoming multimillionaires in either setting, and our all-too-human misperception of risk doesn’t stop at our pocketbooks.

Studies document wildly inaccurate perceptions of risks of skin cancer, food poisoning, cardiovascular disease, accidents caused by texting while driving, and smokeless tobacco. We even believe, quite avidly, that while the American public is getting a tad pudgy, our own hip-to-waist ratios are doing just fine.

Two studies presented in poster form at ASCO’s annual meeting in Chicago highlight some pretty eyebrow-raising misperceptions of risk when it comes to cancer.

Such as – the fact that young adult women profoundly misperceive their lifetime risks of breast and colon cancer, as reported by Katherine Lang and her associates at Virginia Commonweath University in Richmond and Johns Hopkins University in Baltimore.

Ms. Lang and her team analyzed responses from 369 women recruited for a study of cancer risk communication and found that 11% would likely be diagnosed with breast cancer in their lives, based on their family history and other factors. More than twice that percentage, 24%, estimated that they would get breast cancer.

The same trend, with slightly lower levels of misperception, held for colon cancer. While 3% of the group – average age, 33years – faced a real lifetime risk of colon cancer, 19% were convinced they would get the disease.

A second study, this one from Ireland, found that 81% of 525 participants in an online survey were concerned about their cancer risk, while, of course, a far lower percentage would be diagnosed with the disease in the general population.

One in three had no clue that obesity might be a risk factor, but the same percentage believed that wearing a tight bra was a risk. Almost half believed that a blow to the breast could up one’s chance of being diagnosed with breast cancer.

Stress was believed to increase cancer risk by 85% of those queried, and cell phones by 86%. Genetics was deemed by 87% of this largely female (82%) cohort to "strongly" increase risk.

The group, surveyed by a team led by nutritional science student Lisa Burns at University College Cork (Ireland), got the well-publicized message that smoking increases cancer risk (99%). In addition, processed meat (86%), genetically modified foods (81%), food irradiation (77%), cleaning agents (73%), aerosol use (71%), and cheese (29%) were considered cancer promoters by the respondents, 36% of whom held college degrees.

What lowers cancer risk?

The winners in that category were organic food (61%), followed by detox diets (35%), and luck (12%).

The authors concluded that while many members of the general public have an awareness of classic risk factors for cancer such as smoking and a poor diet, "most overestimate risk attributable to genetics, environment, and stress, and underestimate age, obesity, and sunlight."

Most depressing of all to those who would place their bets on cancer prevention messages, "One in 5 believes lifetime risk cancer is non-modifiable," the group concluded.

Dr. Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

If you want to understand how well human beings perceive risk, just stand in line at the gas station when lottery tickets are all the rage, or spend an hour or two loitering at the quarter slots in Las Vegas.

We humans aren’t very swift at calculating the odds of becoming multimillionaires in either setting, and our all-too-human misperception of risk doesn’t stop at our pocketbooks.

Studies document wildly inaccurate perceptions of risks of skin cancer, food poisoning, cardiovascular disease, accidents caused by texting while driving, and smokeless tobacco. We even believe, quite avidly, that while the American public is getting a tad pudgy, our own hip-to-waist ratios are doing just fine.

Two studies presented in poster form at ASCO’s annual meeting in Chicago highlight some pretty eyebrow-raising misperceptions of risk when it comes to cancer.

Such as – the fact that young adult women profoundly misperceive their lifetime risks of breast and colon cancer, as reported by Katherine Lang and her associates at Virginia Commonweath University in Richmond and Johns Hopkins University in Baltimore.

Ms. Lang and her team analyzed responses from 369 women recruited for a study of cancer risk communication and found that 11% would likely be diagnosed with breast cancer in their lives, based on their family history and other factors. More than twice that percentage, 24%, estimated that they would get breast cancer.

The same trend, with slightly lower levels of misperception, held for colon cancer. While 3% of the group – average age, 33years – faced a real lifetime risk of colon cancer, 19% were convinced they would get the disease.

A second study, this one from Ireland, found that 81% of 525 participants in an online survey were concerned about their cancer risk, while, of course, a far lower percentage would be diagnosed with the disease in the general population.

One in three had no clue that obesity might be a risk factor, but the same percentage believed that wearing a tight bra was a risk. Almost half believed that a blow to the breast could up one’s chance of being diagnosed with breast cancer.

Stress was believed to increase cancer risk by 85% of those queried, and cell phones by 86%. Genetics was deemed by 87% of this largely female (82%) cohort to "strongly" increase risk.

The group, surveyed by a team led by nutritional science student Lisa Burns at University College Cork (Ireland), got the well-publicized message that smoking increases cancer risk (99%). In addition, processed meat (86%), genetically modified foods (81%), food irradiation (77%), cleaning agents (73%), aerosol use (71%), and cheese (29%) were considered cancer promoters by the respondents, 36% of whom held college degrees.

What lowers cancer risk?

The winners in that category were organic food (61%), followed by detox diets (35%), and luck (12%).

The authors concluded that while many members of the general public have an awareness of classic risk factors for cancer such as smoking and a poor diet, "most overestimate risk attributable to genetics, environment, and stress, and underestimate age, obesity, and sunlight."

Most depressing of all to those who would place their bets on cancer prevention messages, "One in 5 believes lifetime risk cancer is non-modifiable," the group concluded.

Dr. Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

If you want to understand how well human beings perceive risk, just stand in line at the gas station when lottery tickets are all the rage, or spend an hour or two loitering at the quarter slots in Las Vegas.

We humans aren’t very swift at calculating the odds of becoming multimillionaires in either setting, and our all-too-human misperception of risk doesn’t stop at our pocketbooks.

Studies document wildly inaccurate perceptions of risks of skin cancer, food poisoning, cardiovascular disease, accidents caused by texting while driving, and smokeless tobacco. We even believe, quite avidly, that while the American public is getting a tad pudgy, our own hip-to-waist ratios are doing just fine.

Two studies presented in poster form at ASCO’s annual meeting in Chicago highlight some pretty eyebrow-raising misperceptions of risk when it comes to cancer.

Such as – the fact that young adult women profoundly misperceive their lifetime risks of breast and colon cancer, as reported by Katherine Lang and her associates at Virginia Commonweath University in Richmond and Johns Hopkins University in Baltimore.

Ms. Lang and her team analyzed responses from 369 women recruited for a study of cancer risk communication and found that 11% would likely be diagnosed with breast cancer in their lives, based on their family history and other factors. More than twice that percentage, 24%, estimated that they would get breast cancer.

The same trend, with slightly lower levels of misperception, held for colon cancer. While 3% of the group – average age, 33years – faced a real lifetime risk of colon cancer, 19% were convinced they would get the disease.

A second study, this one from Ireland, found that 81% of 525 participants in an online survey were concerned about their cancer risk, while, of course, a far lower percentage would be diagnosed with the disease in the general population.

One in three had no clue that obesity might be a risk factor, but the same percentage believed that wearing a tight bra was a risk. Almost half believed that a blow to the breast could up one’s chance of being diagnosed with breast cancer.

Stress was believed to increase cancer risk by 85% of those queried, and cell phones by 86%. Genetics was deemed by 87% of this largely female (82%) cohort to "strongly" increase risk.

The group, surveyed by a team led by nutritional science student Lisa Burns at University College Cork (Ireland), got the well-publicized message that smoking increases cancer risk (99%). In addition, processed meat (86%), genetically modified foods (81%), food irradiation (77%), cleaning agents (73%), aerosol use (71%), and cheese (29%) were considered cancer promoters by the respondents, 36% of whom held college degrees.

What lowers cancer risk?

The winners in that category were organic food (61%), followed by detox diets (35%), and luck (12%).

The authors concluded that while many members of the general public have an awareness of classic risk factors for cancer such as smoking and a poor diet, "most overestimate risk attributable to genetics, environment, and stress, and underestimate age, obesity, and sunlight."

Most depressing of all to those who would place their bets on cancer prevention messages, "One in 5 believes lifetime risk cancer is non-modifiable," the group concluded.

Dr. Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

Throughout much of human history, healing and spirituality have been nearly synonymous, the joint purview of medicine men, shamans, and aptly named "faith healers." In modern medicine, though, faith often seems an intruder in the clinic, the clunky out-of-town relative who means well but bumps into the equipment and wrecks the dietary plan with forbidden comfort food.

In psychological circles as well, spirituality and faith are viewed with great discomfort, despite being acknowledged as important facets of patients’ lives. I remember the excruciating moment when I revealed to fellow graduate students a cancer patient’s request that I pray with her during therapy ... and my assent. After a horrified silence, many of my colleagues made strong arguments for referring out such patients for pastoral care. They cited potential conflicts of ideas, boundary-crossing, transference and countertransference – legitimate concerns, all.

In the moment, though, it seemed to me that the patient’s deep yearning was for shared hope in the context of human connection. I did not, and do not, regret that I obliged and was moved by the experience.

What brought these thoughts to the fore was a thoughtful review article published in April by psychiatrist/philosopher John R. Peteet in the journal, Depression Research and Treatment (2012 [doi:10.1155/2012/124370]).

Dr. Peteet, whose thoughtful body of scientific writing has explored many dimensions of suffering, guilt, and forgiveness, as well as matters of the soul, typically drills to the core dilemmas facing clinicians as they seek, in the title of his article a "Spiritually Integrated Treatment of Depression."

His paper masterfully recapitulates the growing body of literature on the spiritual dimension of depression as an outgrowth of hopelessness, existential isolation, and the bleak belief by many sufferers that their darkness is retribution for spiritual weakness.

From those muddy waters – including a literature review that found 56 definitions in 156 papers addressing existential suffering in palliative care settings – Dr. Peteet offers a conceptual framework astonishing in its clarity, comprehensive philosophical scope, and clinical utility.

By summarizing patients’ concerns as emotional, existential, or spiritual, he identifies common belief statements (such as "I don’t know who I am," "There is nothing special about me," or "God is punishing/ignoring me") and offers insight about how each might allow for culturally respectful therapeutic interventions.

A depressed person grappling with meaninglessness, for example, might benefit from spiritually oriented approaches such as mindfulness, meditation, and other meaning-centered orientations, suggests Dr. Peteet, who serves as medical director of the Adult Psychosocial Oncology Program at Dana-Farber Cancer Institute and as a psychiatrist at Brigham and Women’s Hospital in Boston.

Another patient’s spiritual crisis may be guilt infused, and this patient may benefit from forgiveness-promoting positive psychology.

In Dr. Peteet’s conceptualization, there is room for humanistic psychology and the 12-step approach, cognitive behavioral therapy, and psychodynamic work.

He sees healing as coming through reconciliation and attunement, engagement and acceptance.

What does not appear in this very sensitive and contemplative review is the sense that the door between modern medicine and spirituality is one that needs to remain firmly and resolutely closed, best left to religious counselors and the dark solitude of a depressed person’s deepest questions of faith.

Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

Throughout much of human history, healing and spirituality have been nearly synonymous, the joint purview of medicine men, shamans, and aptly named "faith healers." In modern medicine, though, faith often seems an intruder in the clinic, the clunky out-of-town relative who means well but bumps into the equipment and wrecks the dietary plan with forbidden comfort food.

In psychological circles as well, spirituality and faith are viewed with great discomfort, despite being acknowledged as important facets of patients’ lives. I remember the excruciating moment when I revealed to fellow graduate students a cancer patient’s request that I pray with her during therapy ... and my assent. After a horrified silence, many of my colleagues made strong arguments for referring out such patients for pastoral care. They cited potential conflicts of ideas, boundary-crossing, transference and countertransference – legitimate concerns, all.

In the moment, though, it seemed to me that the patient’s deep yearning was for shared hope in the context of human connection. I did not, and do not, regret that I obliged and was moved by the experience.

What brought these thoughts to the fore was a thoughtful review article published in April by psychiatrist/philosopher John R. Peteet in the journal, Depression Research and Treatment (2012 [doi:10.1155/2012/124370]).

Dr. Peteet, whose thoughtful body of scientific writing has explored many dimensions of suffering, guilt, and forgiveness, as well as matters of the soul, typically drills to the core dilemmas facing clinicians as they seek, in the title of his article a "Spiritually Integrated Treatment of Depression."

His paper masterfully recapitulates the growing body of literature on the spiritual dimension of depression as an outgrowth of hopelessness, existential isolation, and the bleak belief by many sufferers that their darkness is retribution for spiritual weakness.

From those muddy waters – including a literature review that found 56 definitions in 156 papers addressing existential suffering in palliative care settings – Dr. Peteet offers a conceptual framework astonishing in its clarity, comprehensive philosophical scope, and clinical utility.

By summarizing patients’ concerns as emotional, existential, or spiritual, he identifies common belief statements (such as "I don’t know who I am," "There is nothing special about me," or "God is punishing/ignoring me") and offers insight about how each might allow for culturally respectful therapeutic interventions.

A depressed person grappling with meaninglessness, for example, might benefit from spiritually oriented approaches such as mindfulness, meditation, and other meaning-centered orientations, suggests Dr. Peteet, who serves as medical director of the Adult Psychosocial Oncology Program at Dana-Farber Cancer Institute and as a psychiatrist at Brigham and Women’s Hospital in Boston.

Another patient’s spiritual crisis may be guilt infused, and this patient may benefit from forgiveness-promoting positive psychology.

In Dr. Peteet’s conceptualization, there is room for humanistic psychology and the 12-step approach, cognitive behavioral therapy, and psychodynamic work.

He sees healing as coming through reconciliation and attunement, engagement and acceptance.

What does not appear in this very sensitive and contemplative review is the sense that the door between modern medicine and spirituality is one that needs to remain firmly and resolutely closed, best left to religious counselors and the dark solitude of a depressed person’s deepest questions of faith.

Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

Throughout much of human history, healing and spirituality have been nearly synonymous, the joint purview of medicine men, shamans, and aptly named "faith healers." In modern medicine, though, faith often seems an intruder in the clinic, the clunky out-of-town relative who means well but bumps into the equipment and wrecks the dietary plan with forbidden comfort food.

In psychological circles as well, spirituality and faith are viewed with great discomfort, despite being acknowledged as important facets of patients’ lives. I remember the excruciating moment when I revealed to fellow graduate students a cancer patient’s request that I pray with her during therapy ... and my assent. After a horrified silence, many of my colleagues made strong arguments for referring out such patients for pastoral care. They cited potential conflicts of ideas, boundary-crossing, transference and countertransference – legitimate concerns, all.

In the moment, though, it seemed to me that the patient’s deep yearning was for shared hope in the context of human connection. I did not, and do not, regret that I obliged and was moved by the experience.

What brought these thoughts to the fore was a thoughtful review article published in April by psychiatrist/philosopher John R. Peteet in the journal, Depression Research and Treatment (2012 [doi:10.1155/2012/124370]).

Dr. Peteet, whose thoughtful body of scientific writing has explored many dimensions of suffering, guilt, and forgiveness, as well as matters of the soul, typically drills to the core dilemmas facing clinicians as they seek, in the title of his article a "Spiritually Integrated Treatment of Depression."

His paper masterfully recapitulates the growing body of literature on the spiritual dimension of depression as an outgrowth of hopelessness, existential isolation, and the bleak belief by many sufferers that their darkness is retribution for spiritual weakness.

From those muddy waters – including a literature review that found 56 definitions in 156 papers addressing existential suffering in palliative care settings – Dr. Peteet offers a conceptual framework astonishing in its clarity, comprehensive philosophical scope, and clinical utility.

By summarizing patients’ concerns as emotional, existential, or spiritual, he identifies common belief statements (such as "I don’t know who I am," "There is nothing special about me," or "God is punishing/ignoring me") and offers insight about how each might allow for culturally respectful therapeutic interventions.

A depressed person grappling with meaninglessness, for example, might benefit from spiritually oriented approaches such as mindfulness, meditation, and other meaning-centered orientations, suggests Dr. Peteet, who serves as medical director of the Adult Psychosocial Oncology Program at Dana-Farber Cancer Institute and as a psychiatrist at Brigham and Women’s Hospital in Boston.

Another patient’s spiritual crisis may be guilt infused, and this patient may benefit from forgiveness-promoting positive psychology.

In Dr. Peteet’s conceptualization, there is room for humanistic psychology and the 12-step approach, cognitive behavioral therapy, and psychodynamic work.

He sees healing as coming through reconciliation and attunement, engagement and acceptance.

What does not appear in this very sensitive and contemplative review is the sense that the door between modern medicine and spirituality is one that needs to remain firmly and resolutely closed, best left to religious counselors and the dark solitude of a depressed person’s deepest questions of faith.

Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

Reflecting a psychological paradigm shift, a number of studies at the American Society of Clinical Oncology 2012 annual meeting focus on individuals’ inherent coping skills, sources of strength, and resilience.

One such study, from Australia, takes the important step of studying resiliency prospectively, drawing important conclusions about which cancer patients are most likely to negotiate the journey just fine, without professional psychological intervention.

Dr. Barbara Kaye Bennett of Prince of Wales Hospital in Sydney led the study of 218 women enrolled just following surgery for early-stage breast cancer. At baseline, she and her associates administered validated measures of mood, somatic symptoms, temperament, illness attitudes, and social support, following up at 1, 3, 6, 9, and 12 months with scales tracking mood and somatic changes.

More than a third of women (34%) never registered clinically relevant signs of psychological or somatic distress during a year of adjuvant treatment and adjustment. Another 15% were temporarily traumatized by the experience, but "recovered promptly and remained well," she reported in a poster displayed at ASCO June 2.

Importantly, the 49% of resilient women did not differ from those with higher psychosocial need in terms of age, marital status, tumor size, treatment modality, or treatment toxicity (nadir hemoglobin and neutrophil count). Mortality was identical, with eight patients in each group dying within 5 years post treatment.

Several factors did distinguish the two groups, including measures of neuroticism, primarily assessed in the study by the Eysenck Personality Questionnaire. Higher scores on the neuroticism scale of the EPQ were strongly, and negatively, correlated with resilience (with a correlation of –.351, P less than.001).

One of the so-called "Big Five" personality traits (openness, conscientiousness, extroversion, agreeableness, and neuroticism), neuroticism basically describes an emotionally reactive, anxious, sensitive, easily rattled temperament, widely believed to be genetic and essentially fixed throughout life.

People who score high on this measure are worriers, somatically focused and more prone than others are to pessimism, anxiety, and depressive symptoms. Resilient patients in the study, then, would be the opposite ... generally calm, optimistic, and not overly sensitive to somatic symptoms.

Other significant findings in the study lent support to the characterization of resilient patients as easy-going, unflappable people. Think of them as "Teflon" rather than "Velcro" responders to major life crises such a diagnosis of cancer and its day-to-day challenges of treatment pain, life disruption, and existential uncertainty.

In the study, they registered lower scores than nonresilient patients on the Illness Behavior Questionnaire scales of anxious concern, disease conviction (hypochondriasis, pain intensity and interference, psychological distress), psychological vs. somatic perception, affective inhibition, and mood disturbance.

Resilient patients perceived higher levels of social support than did their less-resilient peers, but social support was not actually predictive of a resilient psychological outcome. They were also more likely to have received more than 12 years of education and to work more than 20 hours a week – signs, perhaps, of an outward-focused outlook on life.

"Identifying low risk [of psychological distress] may have some important implications," said Dr. Bennett, a postdoctoral fellow in psychology, in an interview from ASCO’s meeting in Chicago. An overabundance of psychological resources for those who do not need them might "undermine [an] individual’s own resources," she noted.

Secondly, it wouldn’t make sense to "squander scarce health resources on those who may not be in need of them and who would not benefit further," if they received counseling or other forms of professional psychosocial care.

If half of patients are so resilient that they tend to do just fine on their own, it’s certainly an observation that deserves more study.

Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

Note: Dr. Bennett and her coauthors had no relevant disclosures.

Reflecting a psychological paradigm shift, a number of studies at the American Society of Clinical Oncology 2012 annual meeting focus on individuals’ inherent coping skills, sources of strength, and resilience.

One such study, from Australia, takes the important step of studying resiliency prospectively, drawing important conclusions about which cancer patients are most likely to negotiate the journey just fine, without professional psychological intervention.

Dr. Barbara Kaye Bennett of Prince of Wales Hospital in Sydney led the study of 218 women enrolled just following surgery for early-stage breast cancer. At baseline, she and her associates administered validated measures of mood, somatic symptoms, temperament, illness attitudes, and social support, following up at 1, 3, 6, 9, and 12 months with scales tracking mood and somatic changes.

More than a third of women (34%) never registered clinically relevant signs of psychological or somatic distress during a year of adjuvant treatment and adjustment. Another 15% were temporarily traumatized by the experience, but "recovered promptly and remained well," she reported in a poster displayed at ASCO June 2.

Importantly, the 49% of resilient women did not differ from those with higher psychosocial need in terms of age, marital status, tumor size, treatment modality, or treatment toxicity (nadir hemoglobin and neutrophil count). Mortality was identical, with eight patients in each group dying within 5 years post treatment.

Several factors did distinguish the two groups, including measures of neuroticism, primarily assessed in the study by the Eysenck Personality Questionnaire. Higher scores on the neuroticism scale of the EPQ were strongly, and negatively, correlated with resilience (with a correlation of –.351, P less than.001).

One of the so-called "Big Five" personality traits (openness, conscientiousness, extroversion, agreeableness, and neuroticism), neuroticism basically describes an emotionally reactive, anxious, sensitive, easily rattled temperament, widely believed to be genetic and essentially fixed throughout life.

People who score high on this measure are worriers, somatically focused and more prone than others are to pessimism, anxiety, and depressive symptoms. Resilient patients in the study, then, would be the opposite ... generally calm, optimistic, and not overly sensitive to somatic symptoms.

Other significant findings in the study lent support to the characterization of resilient patients as easy-going, unflappable people. Think of them as "Teflon" rather than "Velcro" responders to major life crises such a diagnosis of cancer and its day-to-day challenges of treatment pain, life disruption, and existential uncertainty.

In the study, they registered lower scores than nonresilient patients on the Illness Behavior Questionnaire scales of anxious concern, disease conviction (hypochondriasis, pain intensity and interference, psychological distress), psychological vs. somatic perception, affective inhibition, and mood disturbance.

Resilient patients perceived higher levels of social support than did their less-resilient peers, but social support was not actually predictive of a resilient psychological outcome. They were also more likely to have received more than 12 years of education and to work more than 20 hours a week – signs, perhaps, of an outward-focused outlook on life.

"Identifying low risk [of psychological distress] may have some important implications," said Dr. Bennett, a postdoctoral fellow in psychology, in an interview from ASCO’s meeting in Chicago. An overabundance of psychological resources for those who do not need them might "undermine [an] individual’s own resources," she noted.

Secondly, it wouldn’t make sense to "squander scarce health resources on those who may not be in need of them and who would not benefit further," if they received counseling or other forms of professional psychosocial care.

If half of patients are so resilient that they tend to do just fine on their own, it’s certainly an observation that deserves more study.

Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

Note: Dr. Bennett and her coauthors had no relevant disclosures.

Reflecting a psychological paradigm shift, a number of studies at the American Society of Clinical Oncology 2012 annual meeting focus on individuals’ inherent coping skills, sources of strength, and resilience.

One such study, from Australia, takes the important step of studying resiliency prospectively, drawing important conclusions about which cancer patients are most likely to negotiate the journey just fine, without professional psychological intervention.

Dr. Barbara Kaye Bennett of Prince of Wales Hospital in Sydney led the study of 218 women enrolled just following surgery for early-stage breast cancer. At baseline, she and her associates administered validated measures of mood, somatic symptoms, temperament, illness attitudes, and social support, following up at 1, 3, 6, 9, and 12 months with scales tracking mood and somatic changes.

More than a third of women (34%) never registered clinically relevant signs of psychological or somatic distress during a year of adjuvant treatment and adjustment. Another 15% were temporarily traumatized by the experience, but "recovered promptly and remained well," she reported in a poster displayed at ASCO June 2.

Importantly, the 49% of resilient women did not differ from those with higher psychosocial need in terms of age, marital status, tumor size, treatment modality, or treatment toxicity (nadir hemoglobin and neutrophil count). Mortality was identical, with eight patients in each group dying within 5 years post treatment.

Several factors did distinguish the two groups, including measures of neuroticism, primarily assessed in the study by the Eysenck Personality Questionnaire. Higher scores on the neuroticism scale of the EPQ were strongly, and negatively, correlated with resilience (with a correlation of –.351, P less than.001).

One of the so-called "Big Five" personality traits (openness, conscientiousness, extroversion, agreeableness, and neuroticism), neuroticism basically describes an emotionally reactive, anxious, sensitive, easily rattled temperament, widely believed to be genetic and essentially fixed throughout life.

People who score high on this measure are worriers, somatically focused and more prone than others are to pessimism, anxiety, and depressive symptoms. Resilient patients in the study, then, would be the opposite ... generally calm, optimistic, and not overly sensitive to somatic symptoms.

Other significant findings in the study lent support to the characterization of resilient patients as easy-going, unflappable people. Think of them as "Teflon" rather than "Velcro" responders to major life crises such a diagnosis of cancer and its day-to-day challenges of treatment pain, life disruption, and existential uncertainty.

In the study, they registered lower scores than nonresilient patients on the Illness Behavior Questionnaire scales of anxious concern, disease conviction (hypochondriasis, pain intensity and interference, psychological distress), psychological vs. somatic perception, affective inhibition, and mood disturbance.

Resilient patients perceived higher levels of social support than did their less-resilient peers, but social support was not actually predictive of a resilient psychological outcome. They were also more likely to have received more than 12 years of education and to work more than 20 hours a week – signs, perhaps, of an outward-focused outlook on life.

"Identifying low risk [of psychological distress] may have some important implications," said Dr. Bennett, a postdoctoral fellow in psychology, in an interview from ASCO’s meeting in Chicago. An overabundance of psychological resources for those who do not need them might "undermine [an] individual’s own resources," she noted.

Secondly, it wouldn’t make sense to "squander scarce health resources on those who may not be in need of them and who would not benefit further," if they received counseling or other forms of professional psychosocial care.

If half of patients are so resilient that they tend to do just fine on their own, it’s certainly an observation that deserves more study.

Betsy Bates Freed is a clinical psychologist in Santa Barbara, Calif., and a medical journalist.

Note: Dr. Bennett and her coauthors had no relevant disclosures.