Beliefs That Negatively Affect Cancer Treatment

Poor social support and limited financial resources are associated with worse cancer outcomes. Another often-overlooked factor is fatalistic views about cancer—for example, believing that it inevitably leads to death and that nothing can prevent this. These beliefs are also strongly associated with poor outcomes. People holding them are less likely to undergo screening, act early on potential problems or follow treatment recommendations.

On 15 November 2022, BMC Cancer published a preprint in which researchers considered these two well-known phenomena together. They found that fatalistic cancer beliefs affected outcomes as much as adverse socioeconomic and social stressors.

The findings identify a previously unrecognised influence on treatment outcomes and suggest an approach to addressing it: Educating people at risk may help protect them from negative cancer beliefs.

Study Details

Researchers examined cancer knowledge, risk behaviours, screening and sociodemographic characteristics in 859 people in the Philadelphia area.

For each participant, a social determinants of health score was calculated. Scores ranged from 0 to 9, with higher values indicating greater disadvantage. Each factor counted for 1 point:

1. Food insecurity
2. Being non-White
3. Being non-heterosexual
4. Having stable housing
5. Lack of insurance
6. Lack of a university education
7. Living alone
8. Experiencing discrimination
9. Poverty

Participants were also asked how strongly they believed the following statements:

1. Cancer is mostly caused by a person’s behaviour or lifestyle
2. Everything causes cancer
3. There is not much you can do to reduce your risk of cancer
4. There is so much different advice about preventing cancer that it is hard to know what to follow
5. When I think about cancer, I automatically think about dying
6. I would rather not know my cancer risk

Two-thirds of participants were women, 64% were White and 61% were younger than 41. About a quarter lived in poverty, 36% experienced food insecurity and 17% lacked stable housing. The mean social determinants of health (SDOH) score was 2.4.

Study Results

Researchers found statistically significant associations between mean SDOH scores and five of the six life-threatening cancer beliefs. For example, “When I think about cancer, I automatically think about dying” was strongly endorsed by participants with a mean SDOH score of 3.1, compared with 2.3 among those strongly disagreeing. Participants scoring above 2 were more likely to prefer not to know their cancer risk, believe cancer inevitably causes death and agree that little can be done to reduce cancer risk.

People living in poverty were more likely to strongly disagree with “Cancer is mostly caused by a person’s behaviour or lifestyle” and agree with “Everything seems to cause cancer”, “When I think about cancer, I automatically think about dying” and “I would rather not know my risk of developing cancer”.

People experiencing food and housing insecurity were significantly more likely to agree that “Everything causes cancer”, “There is not much you can do to reduce your cancer risk” and “Cancer inevitably leads to death”.

Black and Hispanic participants, described as Americans of Latin American or Spanish origin, were more likely to believe that “Everything causes cancer” and “Cancer directly means death”.

A limitation is that the results cannot be generalised to the whole United States or other countries. The SDOH score also weighted every factor equally, overlooking the greater effect that some social determinants may have.

In conclusion, negative beliefs about cancer that are inconsistent with current developments, also called fatalistic views, were strongly associated with worse disease outcomes. This highlights the need to inform the public about cancer and current treatment outcomes.