Effects of supportive‐expressive group therapy on survival of patients with metastatic breast cancer

Abstract

BACKGROUND. This study was designed to replicate our earlier finding that intensive group therapy extended survival time of women with metastatic breast cancer. Subsequent findings concerning the question of whether such psychosocial support affects survival have been mixed. METHODS. One hundred twenty‐five women with confirmed metastatic (n = 122) or locally recurrent (n = 3) breast cancer were randomly assigned either to the supportive‐expressive group therapy condition (n = 64), where they received educational materials plus weekly supportive‐expressive group therapy, or to the control condition (n = 61), where they received only educational materials for a minimum of 1 year. The treatment, 90 minutes once a week, was designed to build new bonds of social support, encourage expression of emotion, deal with fears of dying and death, help restructure life priorities, improve communication with family members and healthcare professionals, and enhance control of pain and anxiety. RESULTS. Overall mortality after 14 years was 86%; median survival time was 32.8 months. No overall statistically significant effect of treatment on survival was found for treatment (median, 30.7 months) compared with control (median, 33.3 months) patients, but there was a statistically significant intervention site‐by‐condition interaction. Exploratory moderator analysis to explain that interaction revealed a significant overall interaction between estrogen‐receptor (ER) status and treatment condition (P = .002) such that among the 25 ER‐negative participants, those randomized to treatment survived longer (median, 29.8 months) than ER‐negative controls (median, 9.3 months), whereas the ER‐positive participants showed no treatment effect. CONCLUSIONS. The earlier finding that longer survival was associated with supportive‐expressive group therapy was not replicated. Although it is possible that psychosocial effects on survival are relevant to a small subsample of women who are more refractory to current hormonal treatments, further research is required to investigate subgroup differences. Cancer 2007. © 2007 American Cancer Society.

Helplessness/hopelessness, minimization and optimism predict survival in women with invasive ovarian cancer: a role for targeted support during initial treatment decision-making?

“…Interpreting many of these studies is difficult as they fail to effectively control for prognostic factors and do not adequately consider potential interactions between psychosocial and disease or treatment variables over time. 5 Similarly, while psychosocial interventions have demonstrated marked benefits for patient psychological wellbeing and quality of life, the probability of finding survival benefits from such interventions diminishes as methodological rigor increases, particularly in patients with advanced cancer [22][23] Nevertheless, the possibility of a psychosocial impact on outcome remains an intriguing one.…”

Hypnosis in Cancer Patients: Can We Do Better?

“…Hypnosis demonstrated significant superiority over cognitive-existential management, improving QOL scores and reducing depression and anxiety. Other trials included QOL as secondary endpoint (Spiegel, 1989(Spiegel, , 2007Goodwin, 2001), and similar benefits in QOL were reported. Although QOL is a general and easy to use index, too few trials have focused on it.…”

“…Four other randomized controlled trials investigated the impact on survival of educational supportive interventions (group therapy) including self-hypnosis to help patients handle pain or anxiety (Spiegel, 1989;Goodwin, 2001;Kissane, 2007;Spiegel, 2007). Intervention consisted of weekly 90 minutes group sessions where women were encouraged to share and confront their problems, strengthen their relationships, discuss strategies for coping with cancer and find enhanced meaning in their lives.…”

Effects of Supportive-Expressive Group Therapy in Breast Cancer Patients with Affective Disorders: A Pilot Study

“…Furthermore, a DCPR diagnosis was associated with maladaptive coping styles, poor quality of life and a high level of cancer-related worries [50]. Studies are needed that evaluate the effects of group intervention on psychological disorders, as assessed by both standard nosographic systems and the DCPR, given the negative consequences of DCPR diagnoses on quality of life and other measures of health [51,52,53,54]. …”