Holidays, Birthdays and Postponement of Cancer Death

Abstract & Commentary

Synopsis: Contradicting previous studies, no evidence was found in a large review of cancer patients that deaths were postponed relative to significant life events.

Source: Young DC, et al. JAMA. 2004;292:3012-3016.

Death certificate data for the entire state of Ohio for the years 1989-2000 were reviewed to determine if a reduction of cancer deaths was seen in the week preceding Christmas, Thanksgiving or the individual’s birthday. The deaths in the week before the event were compared to deaths in the week following. Nearly 310,000 cancer deaths were analyzed out of a total of some 1.3 million deaths.

No significant difference was found in the proportion of patients dying after the event compared to the week before, and no difference was found either when analyzed by sex, age less than or greater than 70 years, or race. Small differences were noted in actual increases of women dying before their birthdays and African Americans dying before, rather than after, Thanksgiving. There was no seasonal variation in cancer deaths.

Comment by Mary Elina Ferris, MD

Widespread beliefs that death can be postponed by an individual’s will to reach a significant event have recently been contradicted by large analyses such as this study for cancer deaths, and a 30-year literature review in the psychological literature.1 However, smaller studies focusing on specific cultural holidays such as Chinese Harvest Moon2 and the Sabbath (Saturday) for Jewish residents of Israel3 have found a decrease in all-cause mortality before these events, although they have been criticized for small sample size.

Deaths from other causes, such as accidents and cardiovascular sudden death, have actually been shown to increase during the Christmas and New Year’s period. Also supported is seasonal variation in deaths from all causes, particularly in the winter months when respiratory illness are thought to contribute to an increase in deaths.

While epidemiological analyses may miss individual cases with the ability to control the timing of death, and also cannot determine which life events are the most significant for each individual (eg, marriages, relatives' events), this seems to be another case of evidence-based medicine refuting our long-held popular beliefs. While individuals can influence their deaths by their acceptance or refusal of nutrition and therapies, evidence does not support their ability to determine the exact date of death.

Young and associates suggest that physicians and the public have a cognitive bias to recall mainly those deaths that occur after an important event because they are so striking, and assign to them an exaggerated importance. While this may comfort our patients and their families facing imminent death, the evidence here suggests otherwise.

References

1. Skala JA, et al. Psychosom Med. 2004;66(3):382-386.

2. Phillips DP, et al. JAMA. 1990;263(14):1947-1951.

3. Anson J, et al. Soc Sci Med. 2001;52(1):83-97.