July 23, 2007 in Nation/World

Breast cancer groups get jolt

Denise Gellene Los Angeles Times
 

Contradicting an old belief, 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 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 lives of women with metastatic breast cancer, a finding that spurred proliferation of cancer support groups and fueled a debate about the effect of psychology on the course of cancer.

Stanford University psychiatrist David Spiegel, who led both studies, said cancer treatments had improved in the past two decades, making it possible for most patients to live longer without psychotherapy.

Spiegel said the latest study shouldn’t discourage cancer patients from joining support groups, which count thousands of people as 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 those in the group who have died.

Dr. David Kissane, chairman of psychiatry and behavioral sciences at Memorial-Sloan Kettering 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 received weekly group therapy and educational materials, and another that received 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 were not available when he began his first study in the 1970s. The drugs leave “less room for improvement” through group therapy, he said.

Social attitudes about cancer have become more accepting, making it possible for patients to find social and emotional support outside of group therapy, Spiegel said. So the effect of group therapy may be less powerful today than it was 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 nonprofit organization that sponsors support groups, 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,” he said.

Patients acquire better coping skills, he said, and benefit 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 United States each year.

After researchers completed their analysis, he said, they looked to see if 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, a kind that 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.

Among breast cancer patients, 20 percent have the type that is estrogen-receptor-negative.

Group therapy had no effect on 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 the biological mechanism behind group therapy wasn’t known. He said other research has shown that group therapy can reduce levels of the stress hormone cortisol. Abnormal cortisol levels are associated with mortality in women with breast cancer, he said.

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