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When Sabine Dinkel was diagnosed two years ago with advanced ovarian cancer, she pictured herself in a cemetery. After getting over the initial shock, Dinkel, who was born in 1967 and works as a personnel and business start-up consultant in Germany, began looking for advice literature.

What she found depressed her even more. Many books implied that she was to blame for her disease – because she led an unhealthy lifestyle and hadn’t taken proper care of herself.

A widespread belief persists that cancer’s cause lies in the psyche. In a representative survey by the Cancer Information Service of the German Cancer Research Centre, 61% of the respondents agreed with the statement that psychological stress can trigger cancer.

There’s no clear evidence for this, however.

“The notion that you can develop cancer on the basis of your personality traits, stress at the workplace or because you’ve lost a loved one is scientifically untenable,” says Dr Imad Maatouk, a psycho-oncologist at Heidelberg University Hospital.

According to him, the onset of cancer depends on several factors: genetic predisposition, risky behaviours such as smoking, and chance. There’s also no evidence that having a positive attitude can prevent the outbreak or recurrence of cancer.

Dr Maatouk is therefore very sceptical of the “positive thinking” often propagated in self-help books. Nevertheless, patients’ belief in it isn’t bad, he says, since it can give them the feeling of having some control over the disease in its early stages.

While the psyche can’t cure cancer, patients’ sense of well-being and quality of life can be improved with the right strategies. About 30% of cancer patients develop psychological problems as a result of the disease, points out Cancer Information Service director Dr Susanne Weg-Remers.

For some, relaxation techniques help ease their agitation and fear. Many need psychotherapy.

For Dinkel, humour lightened the load. She couldn’t find a light-hearted advice book on cancer, so she wrote one herself: Cancer Is When You Laugh Anyway: How I Suddenly Had Cancer and Regained Courage to Face Life. In it, she calls her disease “Schnieptroete” – a funny-sounding, made-up term of mild abuse – and her fear “Hildegard”.

The way people react to cancer is often difficult for those affected. “Relatives can provide help, but they can also be an additional burden,” notes Dr Weg-Remers.

She advises friends and family members not to simply do what they would expect themselves in such a situation, but to directly ask the patient what he or she needs. Well-meant – but hackneyed – remarks by acquaintances irritate Dinkel.

She has made “cancer-bullshit bingo” out of them at the hospital. The bingo cards are filled with typical phrases from healthy people that she can’t stand hearing, such as “All you’ve got to do is think positive!” or “You’ll beat this!”.

Dinkel’s cancer returned a year after chemotherapy. “I always thought I’d be knocked for six if that happened, but that’s not how it was at all,” she says. She has asked her friends and relatives to send postcards to the hospital with things to do to make her laugh. She calls it “giggle chemo”.

Dinkel has come to accept her situation. Though she probably won’t live to be 100, she says, “I can still have a nice life.” – dpa

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