Effects of supportive‐expressive group therapy on survival of patients with metastatic breast cancer: A randomized prospective trial

Abstract

B ased on a very small subsample of 25 estrogen receptor (ER)-negative women with breast cancer, 13 of whom received group therapy, Spiegel et al. 1 conducted an exploratory analysis that found increased survival for these women. They have argued that these women were not protected by hormonal therapies.In our much larger Australian study of group therapy with women with advanced breast cancer, there were 70 ER-negative women. 2 Kaplan-Meier survival analysis showed no difference between the 43 hormone receptor-negative (estrogen) patients in the group intervention condition and the 27 hormone receptor-negative patients in the control condition. The median survival durations were at 15.5 months (95% confidence interval [CI], 9.5-25.8) for patients in the intervention condition and 17.2 months (95% CI, 8.1-26.5) for patients in the control condition, respectively. The logrank test for equality of survivor functions was not statistically significant (chi-square (2) ¼ 0.55, P ¼ .46).We also tried to replicate their analytic method exactly. In a Cox proportional hazards model we tested the effect of a treatment by positive hormone receptor status interaction, after controlling for intervention site, intervention site by treatment interaction, a treatment main effect, and a positive hormone receptor status main effect. We also centered the predictors as recommended in Kraemer and Blasey, 3 with coding of 1/2 and À1/2 in dichotomous variables (for both the randomization and hormone receptor status variables) and 1-1/m and À1/m for the site dummy variables (where m ¼ 5 in our study). Again, the result was consistent with the Kaplan-Meier survival analysis. There was no hormone receptor status by treatment interaction (Cox proportional hazards B ¼ 1.14, Wald statistic ¼ 0.38, P ¼ .71).Given our inability to replicate their latest exploratory finding, we conclude that it is a chance finding. Women should not be swayed into false hope, but appreciate that strong evidence has emerged that group therapy does not prolong survival. Group therapy does prevent depression and improve quality of life, thus representing a wonderful adjunctive psychosocial treatment for those with cancer. REFERENCES

Cognitive behavioral symptom management intervention in patients with cancer: survival analysis

“…Experts suggest that purposes of psychological interventions need to be directed at improving overall quality of life, rather than extending quantity of life [44]. While survival may not be a realistic ultimate goal of providing psychological intervention, effects of psychological intervention on cancer survival are still worth further exploration.…”

Living with Metastatic Breast Cancer: A Qualitative Analysis of Physical, Psychological, and Social Sequelae

“…Metastatic breast cancer patients randomized to supportive-expressive group therapy have shown improved mood, reduced traumatic stress symptoms, and more adaptive emotion regulation strategies relative to controls (40)(41)(42)(43)(44); however, results of these intervention trials have been mixed (40,45,46). Although supportive-expressive group therapy has been theorized to promote adherence to anti-cancer therapies (47), it has not been found to prolong the survival of metastatic breast cancer patients (46,48,49). In addition, one Cochrane review concluded that trials of cognitive-behavioral and emotion-focused psychotherapy for metastatic breast cancer patients have only resulted in short-term psychological benefits (50).…”

Emotion suppression and mortality risk over a 12-year follow-up

“…Observational studies subsequently lent some empirical support to the idea (55–57), although meta-analytic conclusions of a negligible association (58) sparked controversy further debate over the issue (59). Similarly, trials of supportive-expressive therapy, designed to reduce suppression, have yielded both positive (52, 53) and more ambiguous findings (60, 61) with respect to cancer survival (see also (62–64)). Thus, findings both with respect to incidence and death in the population (15–23), as well as survival in those with cancer (61) have been debated.…”