Cancer support groups may not extend lives
Contradicting an old belief, new research released Sunday found that group therapy didn’t prolong the lives of women with advanced cases of breast cancer.
The report in the journal Cancer found that support groups improved patients’ quality of life and had beneficial effects on mood and pain, but it undercut what had been seen as the greatest potential benefit.
In 1989, a landmark study found that group therapy doubled the survival time of women with metastatic breast cancer. That conclusion spurred a proliferation of cancer support groups and fueled a debate about the effect of such therapy on the course of cancer.
Stanford University psychiatrist David Spiegel, who led both studies, said cancer treatments had improved in the last two decades, making it possible for most patients today to live longer without psychotherapy.
Spiegel said the latest study shouldn’t discourage cancer patients from joining support groups, which count thousands of members and have become an accepted part of cancer care. The groups encourage participants to express fears, anger and depression; confront their doctors; and grieve for those in the group who have died.
Dr. David Kissane, chairman of psychiatry and behavioral sciences at Memorial SloanKettering Cancer Center in New York, who was not connected to the study, said the latest report should end the decades-long debate.
“Group therapy is a great help to women, but it is time to debunk the myth that it extends survival,” he said. “It does not.”
Spiegel undertook the latest study to confirm his older report. Other researchers have attempted to replicate his findings, with conflicting results.
The latest study divided 125 women with advanced breast cancer into two groups: one that got weekly group therapy and educational materials and another that got only educational materials about the disease.
The median survival of all women in the study was 32.8 months, with no differences between the groups.
Spiegel said many of the life-extending drugs used to treat breast cancer today were not available when he began his first study in the 1970s. The drugs leave “less room for improvement” through group therapy, he said.
Society has become more accepting of cancer, making it possible for patients to find social and emotional support outside group therapy, Spiegel said. So the effect of such therapy may be less powerful today than 30 years ago when “cancer was a dirty word,” he said.
“People saw it as a death sentence, and they suffered in silence,” he said.
Mitch Golant, a psychologist and vice president of research and development for the Wellness Community, a Washington-based nonprofit that sponsors support groups, said he didn’t expect the study to affect participation.
“The No. 1 reason why people join support groups is because they want to be with others who are going through what they are going through,” Golant said.
He said such patients acquired better coping skills and benefited from lower levels of stress and anxiety.
“It is great to live longer, but these patients also want to live better,” he said.
Spiegel said he had not ruled out the possibility that group therapy might extend survival in some patients with breast cancer, which kills about 41,000 women in the U.S. each year.
After researchers completed their analysis, he said, they probed the data to see whether there was a subset of patients whose lives might be prolonged by group therapy.
They focused on 25 women with estrogen-receptor-negative breast cancer, which does not respond to a new class of drugs called aromatase inhibitors. They found that group therapy appeared to prolong the lives of these patients -- a finding that Spiegel said must be verified by further study.
One in 5 breast cancer patients has the type that is estrogen-receptor-negative.
Group therapy had no effect on the survival of women whose cancers responded to aromatase inhibitors, he said.
“The overall finding does not support the general idea that group therapy helps you live longer, but whether it helps some people live longer is still an open question,” he said.
Spiegel said that the biological mechanism behind group therapy wasn’t known but that other research had shown that group therapy could reduce levels of the stress hormone cortisol. Abnormal cortisol levels are associated with mortality in women with breast cancer, he said.
Dr. George Somlo, co-director of the breast cancer program at City of Hope in Duarte, who was not connected to the study, said the subset analysis should be viewed cautiously because it involved a small number of patients. Women who got group therapy in the study had higher average incomes, which might explain the health outcomes seen in the subset analysis, he said.
Kissane, who previously found no group-therapy survival benefit among 70 estrogen- receptor-negative women, called the finding a “chance result of no significance.”