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Volume 345:1719-1726 December 13, 2001 Number 24 Next

	Full Text PDF Editorial by Spiegel, D. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Supportive–expressive group therapy has been reported to prolong survival among women with metastatic breast cancer. However, in recent studies, various psychosocial interventions have not prolonged survival.

Methods In a multicenter trial, we randomly assigned 235 women with metastatic breast cancer who were expected to survive at least three months in a 2:1 ratio to an intervention group that participated in weekly supportive–expressive group therapy (158 women) or to a control group that received no such intervention (77 women). All the women received educational materials and any medical or psychosocial care that was deemed necessary. The primary outcome was survival; psychosocial function was assessed by self-reported questionnaires.

Results Women assigned to supportive–expressive therapy had greater improvement in psychological symptoms and reported less pain (P=0.04) than women in the control group. A significant interaction of treatment-group assignment with base-line psychological score was found (P0.003 for the comparison of mood variables; P=0.04 for the comparison of pain); women who were more distressed benefited, whereas those who were less distressed did not. The psychological intervention did not prolong survival (median survival, 17.9 months in the intervention group and 17.6 months in the control group; hazard ratio for death according to the univariate analysis, 1.06 [95 percent confidence interval, 0.78 to 1.45]; hazard ratio according to the multivariate analysis, 1.23 [95 percent confidence interval, 0.88 to 1.72]).

Conclusions Supportive–expressive group therapy does not prolong survival in women with metastatic breast cancer. It improves mood and the perception of pain, particularly in women who are initially more distressed.

Source Information

From the Departments of Medicine (P.J.G.), Psychiatry (M.L., J.H.), and Nursing (L.V.), and the Division of Clinical Epidemiology at the Samuel Lunenfeld Research Institute (P.J.G., M.E.), Mount Sinai Hospital, University of Toronto, Toronto; the Department of Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, Alta. (J.K., M.S.); the Department of Supportive Care, Hamilton Regional Cancer Center, Hamilton, Ont. (H.G.); the Department of Psychiatry, University of British Columbia, Vancouver, and the British Columbia Cancer Agency, Vancouver (E.D.); the Department of Psychology, University of Alberta, Edmonton, and the Cross Cancer Institute, Edmonton, Alta. (M.H.); the Department of Psychiatry, University of Manitoba, Winnipeg, and CancerCare Manitoba, Winnipeg (H.M.C.); and the Department of Psychiatry, University of Ottawa, and the Ottawa Regional Cancer Center, Ottawa, Ont. (M.N.) — all in Canada.

Other authors were Julia Masterson, M.D., Department of Supportive Care, Hamilton Regional Cancer Center, Hamilton, Ont.; Liz Dohan, M.S.W., Department of Patient and Family Counseling, British Columbia Cancer Agency, Vancouver; Rami Sela, Ph.D., Department of Psychology, University of Alberta, Edmonton; Barbara Warren, R.N., M.S.N., CancerCare Manitoba, Winnipeg; Alexander Paterson, M.D., Department of Oncology, University of Calgary, Calgary, Alta.; Kathleen I. Pritchard, M.D., Department of Medicine, and Andrew Arnold, M.B., B.S., Department of Oncology, Mount Sinai Hospital, University of Toronto, Toronto; Richard Doll, M.S.W., Department of Patient and Family Counseling, and Susan E. O'Reilly, M.D., Department of Oncology, British Columbia Cancer Agency, Vancouver; and Gail Quirt, R.N., B.A.A., and Nicky Hood, R.N., Mount Sinai Hospital, University of Toronto, Toronto — all in Canada.

Address reprint requests to Dr. Goodwin at Mount Sinai Hospital, 1284-600 University Ave., Toronto, ON M5G 1X5, Canada, or at pgoodwin{at}mtsinai.on.ca.

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