Sep 27 2004
A new study shows that cognitive-existential group therapy (CEGT), a psychosocial intervention designed to improve the mood and attitude of patients with breast cancer, does not improve survival of women with early-stage disease.
The study, to be published online September 27 in the Journal of Clinical Oncology, is the first to evaluate the impact of CEGT on the survival of early-stage breast cancer patients, and was conducted after previous studies of group therapy in women with metastatic breast cancer yielded mixed results.
“Although the results of this study do not demonstrate a survival benefit for patients receiving CEGT, they add to our body of knowledge of how psychosocial interventions can be used to help patients manage their disease,” said David W. Kissane, MD, lead author and Chairman of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan-Kettering Cancer Center. “We hope that this study will help to frame future research on how group therapy can be used to improve patients’ quality of life.”
Group therapy was initially used in the oncology setting to help patients cope with the emotional challenges of living with cancer. However, more recently, a number of controlled clinical trials have sought to determine whether group therapy has any impact on survival in patients with metastatic breast cancer. An equal number of studies have shown evidence that supports or negates a survival benefit.
The current study evaluated the impact of CEGT on survival in patients with early-stage breast cancer, randomly assigning 303 women to receive adjuvant chemotherapy and 20 sessions of weekly group therapy plus 3 relaxation classes (n = 154), or adjuvant chemotherapy and 3 relaxation classes alone (n = 149). Researchers found no survival difference between patients receiving CEGT and those who did not. The most significant predictors of survival were the histology of the tumor and the number and location of lymph nodes to which cancer cells had spread.
An accompanying editorial by Pamela J. Goodwin, MD, MSc, FRCP(C) of the Samuel Lunenfeld Research Institute at Mount Sinai Hospital in Toronto, Canada, places the negative results of the study by Dr. Kissane and his colleagues in the context of the progress made in the larger field of psycho-oncology research. She argues that the study reinforces growing evidence that group therapy and other forms of psychosocial intervention are associated with improvement in mood, coping skills, and quality of life in women with breast cancer, and that the study provides direction for future research in the field of psycho-oncology.
“What is remarkable is the breadth of interventions that have been shown to be effective in one situation or another,” Dr. Goodwin said. “Surprisingly little research has evaluated the impact of individual interventions in breast cancer, commonly used in the clinical setting. Formal evaluation of such interventions, as well as continuing research elucidating which interventions are most beneficial to different patient populations should form the basis for research in this area during the next decade. Toward this end, Kissane et al’s negative result should have a positive impact on the field of psycho-oncology as a whole.”