"I didn't get cancer for nothing."

"Get your affairs in order," the doctor told Patricia.

Three months earlier, the 32-year-old primary school teacher had several metastasized lymph nodes removed from her armpits. Now, the oncologist had again discovered cancer cells in the tissue of her surgical scar. The prognosis for the young mother: not good.

According to the World Health Organization (WHO), an estimated 9.6 million people worldwide died of cancer in 2018. The disease is particularly fatal for people living in poor countries.

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Patricia, though, has survived her illness. And not only that — if she looks back, she feels as though her lifestyle before her diagnosis almost set her up for her misfortune.

In fact, according to the WHO, 30 to 50 percent of all cancers could be avoided. Risk number one: tobacco. This is followed by alcohol and obesity. The organization also mentions infections, environmental pollution and ionizing radiation as carcinogens.

Cancer as a self-fulfilling prophecy?

But Patricia mentions something else: her mind. "With my attitude to life, I engineered this fate for myself, to a certain extent," she says. She had a poor sense of self-worth, and was pessimistic.

"One thought that was always in the back of my mind was that something bad would happen to me at some point."

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Can a negative psyche serve as a breeding ground for cancer? "This is an extremely intriguing question from a scientific point of view," Christian Albus, professor of medicine at the University of Cologne, told DW.

The question of whether and to what extent the psyche allows cancer to thrive has been intensively discussed in psychosomatic research. "In individual cases, there are indications of this. However, the hypothesis doesn't stand up to scientific scrutiny," Albus explains.

Studies with larger groups have shown that groups of cancer patients before the onset of the disease are not fundamentally more negative about life than people who never end up developing cancer.

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However, when it comes to coping with the disease, attitudes matter, the professor says. "Some people are tormented by heavy feelings of guilt because they believe that the cancer would not have developed if their attitudes to life had been different."

In the beginning, there was shock

Patricia, on the other hand, came to a different conclusion. "If I had something to do with the fact that I've got cancer, then I can turn it around." She saw the diagnosis as an opportunity to review her attitude towards life.

But it took her several years to get to that point.

Years that the young mother spent in shock. She felt bound by the fear of imminent death. She refused chemotherapy and radiation, saying she was sure she was going to die anyway. “I thought: what’s the point of undergoing therapies with drastic side effects?”

But she emphasizes that she is not opposed to these treatment methods, and doesn’t know if she would make the same decision were she diagnosed with cancer again.

Patricia initially declined to seek out mental health support, having grown up assuming that psychotherapy is only for those deemed “crazy."

It was her pregnancy with her second child that released her from shock-induced paralysis. She started therapy and uncovered the roots of her anxiety. She learned to talk about painful experiences, such as the stillbirth of her first child and theassociated feelings of guilt. The cancer-survivor says she has gradually grown to be more self-confident.

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Mental health crucial for the healing process

From a scientific point of view, mental wellbeing may have little to do with cancer, but the mental health of the patient is crucial in the course of the disease, says Albus. "There is a statistically significant correlation between long-term depression and the likelihood that the disease will progress unfavorably."

But this does raise the dilemma of the chicken and the egg — what comes first? "Are people with worse diagnoses more depressed or do those who are depressed have a worse experience of cancer?" That is a question not yet conclusively answered, says Albus.

Despite an extremely bad prognosis, Patricia lives. And she is doing well. Her regular check-ups indicate she is healthy. "At some point I became certain the cancer wouldn’t come back."

"Accept the circumstances and change them. Or die."

Patricia no longer works only as a teacher. She has also founded her own business, called "Familienbande" (family ties). She offers advice and support to families, children and young people in difficult situations. The knowledge she gained from her diagnosis and her subsequent therapy has inspired her to help others.

"Without the cancer, I wouldn't be where I am now," she says.

Ultimately, cancer was a wake-up call for Patricia — a catalyst for her to pursue a better life. But hers is not an isolated case.

"It happens a lot," says Albus. Many people upend their approach to life after being confronted with a serious illness, says Albus. "Have I set the right priorities? What is really important? These questions tend to come to the fore."

Not every patient needs professional therapy to find an answer. According to Albus, at least half of all cancer patients cope with the disease solely with the help of their own personal community.

Patricia, however, swears by the help of psychotherapy. She suspects the origin of the disease lay in her negative attitude towards life. For her, it was obvious that if she wanted to get better, that’s what she would have to change. "My task was to accept the circumstances and change them. Or die."