People who are told that they have cancer are often advised to stay positive. But doing so does nothing to help you to survive the disease, a study has indicated.

The self-help guru Louise Hay extolled the virtues of positive thinking in her book, You Can Heal Your Life, which has sold 35 million copies worldwide over the past 20 years. Some small studies have suggested a benefit.

But the latest study, published in the journal Cancer, provides strong evidence that while it may be good advice to remain as upbeat as possible the cancer doesn’t take any notice.

James Coyne, of the University of Pennsylvania, said that previous studies used patients with many different diseases, small sample sizes and an inadequate number of deaths to be conclusive. Instead, he used data from two studies of patients with head and neck cancer to examine whether emotional wellbeing at the time the study started had any effect on survival. His sample consisted of 1,093 patients who completed a quality-of-life questionnaire during treatment.

This included an emotional wellbeing (EWB) scale, which was calculated by asking participants how closely various statements such as “I feel sad” and “I am losing hope in my fight against my illness” reflected their own personal feelings. The higher the score on the EWB scale, the more emotional wellbeing and the less depression.

Over the course of the study, 646 of the patients died. The analysis showed that emotional status was not linked to survival. The team concludes that emotional status “neither directly affected progression or death, nor functioned as a lurking variable”.

The study is one of the largest of its type because it involved so many deaths, but its conclusions are no different from an earlier analysis of the literature by Dr Coyne and two colleagues, Stephen Palmer, of the University of Pennsylvania, and Michael Stefanek, of the American Cancer Society.

They looked at studies that had been done and concluded, in Psychological Bulletin, that there was no credible evidence that patients’ participation in psychotherapy or support groups prolonged their lives. Dr Coyne said: “The hope that we can fight cancer by influencing emotional states appears to have been misplaced. If patients want psychotherapy or to be in a support group they should be given the opportunity. There can be lots of emotional and social benefits. But they should not seek such experiences solely on the expectation that they are extending their lives.”

Dr Coyne was not optimistic that entrenched public attitudes would be quickly changed. Media stories about celebrities with cancer almost invariably report that they are planning to “fight” their cancer, presenting the issue as a battle between the determination of the patient and the inexorable advance of the disease.

Kylie Minogue, whose breast cancer was diagnosed on the eve of a tour in the summer of 2005, said that she always tried to retain a positive attitude. In an interview last year after a tumour had been removed in a partial mastectomy, she said: “Always one to rise to the challenge, I thought, ‘Okay, okay, you’ve got to fight it. Even the smallest thing makes a difference. I love to say, you can get through it’.”

Such stories are boosted by studies that report an effect on mental state. For example, a 2000 study by Professor Leslie Walker, of the University of Hull, looked at 80 women with breast cancer. All were given the same treatment and emotional support. Half were also taught relaxation techniques. Professor Walker found evidence in the patients’ white blood cells that relaxation had an effect, but the study did not measure survival rates.

An earlier study at the Royal Marsden Hospital in London also used breast cancer patients. Six hundred were questioned and 166 were found to have “fighting spirit”. But this had no bearing on the eventual outcome – except in the women with the most negative thoughts, which did appear to worsen chances of survival.

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