Our experiences dramatically confirm the power of negative expectations. That power is particularly frightening when we consider the general beliefs about cancer in our society and their probable effects on cancer patients. In somewhat oversimplified terms the beliefs about cancer in our society are:

  1. Cancer is synonymous with death.
  2. Cancer is something that strikes from without and there is no hope of controlling it.
  3. The treatment—whether radiation, chemotherapy, or surgery—is drastic and negative and frequently has many undesirable side effects.

If expectancies contribute to outcomes, then these social beliefs are having a heavily negative effect. Newspapers and magazines carry stories of people who have died following a long battle with cancer. The overt inspirational message of these stories is usually how brave these people were. The hidden message is that they were brave in the face of their inevitable death. Often, when people speak of someone who has cancer, the tone of the conversation changes, there is an awkward silence, the listeners look away—all connoting the expectation of death.

Cancer patients, of course, become very sensitive to such negative messages. Many report that their friends, upon finding out about their illness, begin to avoid them, apparently 1 not knowing how to relate to them any longer since they are I already "as good as dead." Much of other people's avoidance of cancer patients is based on an avoidance of thinking J about death, as well as the fear that somehow cancer is catching.

This tragic set of negative expectancies is communicated not only by friends and relatives but also at times by the medical profession. A physician who was previously an understanding expert with ready answers may, in the presence of a patient diagnosed with cancer, become a somewhat inept philosopher trying to comfort with platitudes in the face of what he regards as inevitable death. In many cases, the most profound communication from the physician is his evading the patient's questions. One patient described her physician when he came to her hospital room after a surgical biopsy to tell her she had cancer. He only came two feet inside the door and stood with his body against the wall. He quickly told her she had cancer, would need further treatment, and would be referred to another doctor. Then just as quickly he left the room. Naturally, the patient senses the physician's attitude through both verbal and nonverbal cues. The message is clear: The patient will not survive.

None of this is said in condemnation of other physicians—or of the patient's disconcerted friends and family. We are simply describing facts. We are all too aware of the times when our own negative expectancies have been communicated or when our own sense of inadequacy has contributed to the patient's feelings of helplessness. The lamentable outcome of all these communicated expectations of side effects, pain, and death is that they can work to create a self-fulfilling prophecy. With different beliefs and expectations, however, the outcome can be different.