Effects of counseling for late stage cancer patients

Abstract

Much has been written about working with the dying. Few, if any, controlled studies have examined the application of principles set forth. The authors evaluate the effectiveness of working with dying cancer patients by assessing changes in quality of life, physical functioning, and survival. One-hundred twenty men with end-stage cancer were randomly assigned to experimental or control groups; the 62 experimental group patients were seen regularly by a counselor. Patients were assessed before random assignment and at one, three, six, nine, and 12 months on quality of live and functional status. Experimental group patients improved significantly more than the control group on quality of life within three months. Functional status and survival did not differ between groups. A subsample of lung cancer patients provided cross-validation of findings. Although survival was not expected to differ, it was predicted that functioning would be enhanced if quality of life improved. One interpretation is that little can be done to alter physical function and survival when intervention occurs late in the progression of a fatal disease. This in no way reduces the value of improving overall quality of life, since enhancing the quality of survival for end-stage cancer patients is a high priority medical goal.

Support groups in advanced breast cancer

“…There have been at least five randomized trials of the survival effects of psychosocial interventions in other cancer settings 2,3,7,8 : Three of those trials evaluated group interventions, and two trials 2,7 evaluated individual interventions. In the first of these trials, 7 men with various types of cancer received individual counseling.…”

“…In the first of these trials, 7 men with various types of cancer received individual counseling. Counseling often was offered very late in the course of the disease.…”

“…Other randomized trials in patients with lung cancer and mixed cancers have shown no survival benefits. 7,8 Although clearly mixed, these results bolstered interest in potential survival benefits of psychosocial interventions.…”

“…7 These support groups were led by individuals with various professional credentials. Some of these groups were conducted by trained professionals in cancer centers or other healthcare settings; however, many groups were conducted by members of the lay community (often cancer survivors themselves) with very little training or supervision.…”

“…Some of these groups were conducted by trained professionals in cancer centers or other healthcare settings; however, many groups were conducted by members of the lay community (often cancer survivors themselves) with very little training or supervision. 7 The groups varied in duration from a few meetings to months or years of weekly meetings. Furthermore, the nature of the interventions varied, with some groups focusing on support, some with strong religious or meditation components, and some attempting (with various degrees of success) to replicate the intervention reported by Spiegel et al Although these efforts are laudable, and although the groups helped many participants, this was not always the case, 9,10 and there often were misconceptions about their potential benefit.…”