Group therapy fails to improve breast cancer survival

A follow up to a previous study on group therapy in breast cancer patients finds group therapy does not prolong the lives of women with metastatic breast cancer. Published in the September 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the new case-control trial finds patients with metastatic breast cancer who took part in weekly group psychotherapy had similar survival rates as those given literature-based patient education. Earlier results from the same researcher had suggested a survival benefit of group therapy for women with metastatic breast cancer. However, the new study did find that women with estrogen receptor (ER) negative tumors did show survival benefit, and that group therapy improved quality of life (QOL).

Early reports in the 1980s and 1990s, including published studies by Dr. David Spiegel from Stanford University, found that group psychotherapy for women with metastatic breast cancer improved survival. Dr. Spiegel’s 1989 study found that women who received group therapy for one year were more likely to be alive 18-months after diagnosis compared to a group of patients who received no therapy.

Four subsequent studies had similar results, but six other studies failed to confirm the finding. Dr. Spiegel and co-investigators sought to replicate their original finding in a new randomized prospective study. For the new study, half (64 of 125) of a group of 125 women with metastatic breast cancer received one year of weekly group support and psychotherapy, in addition to one year of educational literature offered to all subjects. All also received standard oncological treatment for their metastatic breast cancer.

Dr. Spiegel and colleagues found no difference in overall survival between the two groups. Women who received supportive group therapy survived a median of 31 months, while group that received educational literature survived a median of 33 months. Further analysis did show a clear benefit for women with ER-negative tumors. Median survival in women with ER-negative tumors who received group therapy was 21 months longer than those who received educational literature (30 months versus 9 months). There was no survival benefit from psychotherapy treatment among women with ER-positive tumors. These women have benefited from improved hormonal treatments, such as aromatase inhibitors.

While there was no overall survival difference due to group therapy, Dr. Spiegel and colleagues point to the clear psychological benefit of group psychotherapy for women with metastatic breast cancer, writing that “being confronted with their ‘worst fears’ as they see others die of the same illness, with help in managing the strong emotions that understandably arise, is emotionally helpful for patients and not physically harmful.”
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Article: “Effects of Supportive-Expressive Group Therapy on Survival of Patients with Metastatic Breast Cancer: A Randomized Prospective Trial,” David Spiegel, Lisa D. Butler, Janine Giese-Davis, Cheryl Koopman, Elaine Miller, Sue DiMiceli, Catherine C. Classen, Patricia Fobair, Robert W. Carlson, Helena C. Kraemer, CANCER; Published Online: July 23, 2007 (DOI: 10.1002/cncr. 22890); Print Issue Date: September 1, 2007.