Placebo Effect in Cancer Treatment

Simply, a placebo can be described as an inert substance which has no medically proven healing ability or positive physiological effect yet can improve the receivers symptoms of a condition. However, the definition of a placebo has become murky in recent times as we are becoming more aware of other aspects of healthcare which seem to contribute to the overall placebo effect.

Traditionally, the placebo effect was regarded as the positive effects experienced by a patient after receiving a placebo, which they believed to be an active drug. We now have wider understanding into healthcare psychology and the study/use of the placebo effect has become far more advanced to that of Henry Beechers. Studies today not only look at the deceptive power of the placebo but look more so towards how patient-practitioner engagement, healthcare set ups, treatment protocols, past experiences, culture, expectation, desire, optimism, trust and even how treatment delivery and communication can improve symptom relief in patients.

Some individuals can experience placebo effect without receiving a drug, injection, or procedure. Some may just simply feel better from visiting a practitioner or doing something they believe will help, like living a healthier lifestyle. However, this type of placebo effect seems most related to the degree of confidence and faith the patient has in the practitioner/treatment.

The most common way to test the effectiveness of a placebo is using a double-blind controlled study, where neither the individuals taking part in the study or doctors know who’s receiving which treatment. This helps avoid biases in measuring outcomes that can be caused by the researchers or the patients’ expectations about the treatment. This is not as big a problem in studies of cancer treatment, where objective outcome measures are most often used. It’s more likely in studies that require patient reporting for symptoms like depression, sleeplessness, or pain.

As placebos often have an effect, even if the effect doesn’t last long, some people think that the placebo produced a cure. However, we know that placebos do not cure, at least not cancer. And in studies looking at whether a tumor shrinks, placebos have very little effect, if any, on reducing tumor growth. Still, physical placebos clearly can help reduce certain symptoms such as pain, anxiety, and trouble sleeping. There is a theory that a placebo may help the brain remember a time before the symptoms and bring about certain chemical changes - A theory named remembered wellness.

It is imperative to consider the importance that cultural differences may have in the clinical setting, particularly in the identification of signs and cues within the patient–practitioner interaction, Although this adds a degree of complexity to the practitioner who is part of the bi-cultural patient–practitioner relationship.

Patients who already have some faith in a particular method are more likely to sign up for a study about that method. For example, people who have faith in their doctors methods are more likely to sign up for a study on medical treatment. Individuals who believe that meditation works are likely to volunteer for a study investigating meditation impacts. Likewise, those who don’t believe in a certain procedure probably won’t sign up to test it. This means that the group who volunteers for the study already has some expectation effect before the study starts. Many who take part will likely report at least a brief improvement in symptoms with the treatment, or even with a placebo, because they expect to be helped by the treatment. One particular study found that reward expectation accounted for 28% of the variance in the formation of placebo analgesia.

Many people feel better after they get medical treatments that they expect to work. The opposite can also happen, and this seems to support the idea of the expectation effect even more. For example, in one study, people with Alzheimer disease got less relief from pain medicines. These patients required higher doses – possibly because they had forgotten they were being administered the drugs, or they forgot that the pain medicines had worked for them before. This suggests that past experiences also play into the placebo effect and support the theory of remembered wellness mentioned earlier.

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There has been numerous studies which have shown a direct correlation between an individuals belief and physiological change. According to one study of 84 hotel maids, those who were told that they meet sufficient exercise levels solely through their work showed a decrease in weight, blood pressure, body fat, waist-to-hip ratio, and body mass index. Perhaps if cancer patients focus more on the positive aspects and habits of their lifestyle which are conducive to improved health, they could experience better and faster recoveries.

In one study using the drug maxalt, different labelling of placebos and the actual drug found that by simply labelling the true drug container with “maxalt” symptoms significantly decreased as compared to a true drug container labelled “placebo”. If one word can have this much of an impact on patient belief in a drug, the effectiveness of a treatment plan could be massively increased by the way the radiation therapist communicates with the patient. If a practitioner personally believes in a treatment and communicates that the treatment will likely work - patients will be more likely to see an improvement.

Creating a positive doctor–patient relationship can help decrease the quantity of medication used, and therefore, experienced side effects. A recent review found that there is substantial evidence that positive therapeutic relationships between patients and practitioners are correlated with improvements in quality of life, anxiety and depression levels, as well as patient satisfaction and treatment adherence. Interactions that hold a business-like character and that create doubt and uncertainty around the practitioner’s skills and competencies could lead to nocebo effects or to a reduction of placebo effects.

Identifying patient mindsets may serve as an efficient way for evaluating a patient’s stance on different aspects of the clinical interaction and setting, including previous experiences and expectations regarding treatment plans and other outcomes. In addition to the practitioner’s expression of certain psychosocial characteristics within their role, other actions can be taken to enhance the placebo and prevent the placebo effect. For instance, a practitioner could avoid over-emphasising negative information regarding a treatment by balancing it with information about the positive effects in a truthful and ethical manner that preserves the right of patients to make decisions about their medical care without their health care provider trying to influence the decision - otherwise known as patient autonomy. Therefore, a radiation therapist should always have a positive and optimistic outlook when delivering information but should never try to deceive a patient. Information regarding treatments, success rates and possible issues should be presented in a truthful way but remain focussed on the positives. The first and last points discussed should not be negative.

Preventing interactions that are uncaring, judgmental and insensitive, which send a message of invalidation and lack of warmth, while at the same time creating a safe and positive environment for patients to begin internalising their own process of healing, can prevent the nocebo effect while promoting the activation of placebo effects.

Perhaps the largest benefit of the placebo effect for radiation therapy patients lies in the reduction of health risk factors which can reduce treatment effectiveness. Many studies have shown how negative lifestyle aspects can increase our health risks. However, there are less obvious lifestyle habits which could reduce treatment efficacy besides obesity, high blood sugar, alcohol consumption, smoking, CHD, stress, or poor diet. For example, in June of this year late night shift work was listed as a possible carcinogen. Perhaps a simple suggestion to change shift work may help with treatment success rates. Other studies have shown how losing just one hour of sleep through daylight savings time can increase our risk of heart attack by 24%, which shows just how important sleep is for our health and reducing illness. By using existing knowledge on the importance of diet, sleep, exercise, stress management etc radiation therapists could greatly increase patients overall health and the bodies ability to fight against cancer.

Conclusion

The placebo effect is more than just the effect that the administration of an inert substance, or “sugar pills” deceptively to a patient. It is a way in which we can quantify and measure everything that surrounds pills and procedures. Rituals, words,engagement, beliefs, diplomas, clothing, and anticipation of improvement are all aspects of the wider placebo effect when patients visit a healthcare practitioner. In radiation therapy, the placebo effect is more about how we can create a healthcare environment that can help alleviate patient symptoms, stress, anxiety and worries without the use of pharmaceuticals or treatments. By creating a favourable environment, the placebo effect can be increased and used to the advantage of patients as an aid to reduce health risk behaviours associated with negative impacts on treatment outcomes.

The placebo effect studies discussed above show how the effects of mindset, perception, and outlook of both the patient and practitioner can largely determine health improvement. Furthermore, the placebo effect shows us that sometimes the best way to fix what’s wrong with our health is by focusing on what’s right with our health. I still think that no matter how hard practitioners attempt to improve a patients outcome, ultimately it is the individuals choice to adopt a healthier lifestyle and believe in their treatment. When it comes to health, there is often not much choice involved, but fortunately this is an aspect of healthcare which the practitioner can play a pivotal role.

References

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