Group Therapy Not A Boost To Cancer Survival

STANFORD
Group therapy not a boost to cancer survival after all
Psychological support doesn't extend life for most breast patients, says researcher

Erin Allday, Chronicle Staff Writer

Monday, July 23, 2007

A Stanford psychiatrist who was a pioneer for treating breast cancer patients with group therapy has joined the ranks of researchers who have found that such therapy may not improve cancer survival after all.

In a paper published today in Cancer, the journal of the American Cancer Society, Dr. David Spiegel said he was unable to duplicate results of a famous study he conducted 30 years ago that showed women in group therapy survived twice as long as those who were not in therapy.

Spiegel's recent research, which studied 122 women who had metastatic breast cancer, showed no statistical difference in survival times between participants in group therapy and those who weren't.

But Spiegel and other researchers said there is no question that many patients get notable quality-of-life improvements from group therapy. And a small subset of women with a specific kind of breast cancer -- estrogen-negative cancer -- did have markedly better survival times with group therapy -- they survived 30 months compared with just nine months for those who didn't get therapy.

"I think the key issue is that facing your death doesn't hasten it," Spiegel said. "It may not extend your life, but it sure as hell doesn't shorten it, and it helps you live better because you're dealing with what you have to deal with."

Studies of group therapy and its influence on cancer treatment have produced mixed results over the past three decades since Spiegel published his first report. But researchers said that more recent studies don't necessarily negate Spiegel's earlier findings -- cancer treatment is a moving target and breast cancer therapies in particular have seen huge advances since the 1970s.

In Spiegel's new study, women were divided into a control group that was given educational materials about metastatic breast cancer but no psychotherapy, and a second group that participated in 90-minute, weekly group-therapy sessions. The study lasted for 14 years.

The women in group therapy survived an average of 30.7 months, compared with 33.3 months for the control group; researchers did not consider the difference statistically significant.

Explaining why his results differed from the first study, Spiegel said it's possible that medical treatments have improved so much that there is no room for psychotherapy to offer additional increases in survival time.

But a subset of women with estrogen-negative breast cancer has not seen such improvements in medical treatments, most notably hormone therapy. Because estrogen-negative cancer is so difficult to treat with medicine, treating women in psychotherapy may make a significant difference, Spiegel said. That may be why, in the new study, women with estrogen-negative cancer who got group therapy had far better survival times than women who did not get psychotherapy.

It's also likely that wide acceptance of psychotherapy in the last 30 years -- and even people becoming more comfortable talking about cancer with their family and friends -- has improved outcomes for everyone.

Spiegel noted that in his original study, he had a hard time persuading women to agree to group-therapy meetings. In his later study, his control group patients were disappointed to not be assigned psychotherapy.

"One of the (control patients) showed up in my office and wanted a list of the other control patients so she could start a support group of her own," Spiegel said. "We had to tell her no."

Even if the group therapy does not improve survival times, there's no doubt it improves the quality of life for many women with breast cancer, psychiatrists said. Several studies have shown that group therapy helps reduce pain and anxiety in patients with cancer and chronic diseases.

It can also help people get the most out of whatever time they have left when facing a fatal disease, said Dr. Robin Dea, a psychiatrist at Kaiser Permanente's Redwood City Medical Center.

"People are realizing that whether there is an actual difference in survival is maybe not the only thing that's important here. Maybe the quality of life during survival is every bit as important," Dea said.

Barbara Brenner, executive director of the San Francisco nonprofit Breast Cancer Action, said not all women are comfortable with group therapy and it's important for them to see studies like Spiegel's so they know they aren't hurting their chances for survival.

"When you get breast cancer, someone always says, 'You should join a support group, you'll live longer,' " Brenner said. "Women will beat themselves up if they're not interested in support groups."



This article appeared on page D - 1 of the San Francisco Chronicle