Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer§

A randomized prospective trial

Authors

  • David Spiegel MD,

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
    • Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5718
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.

    • Fax: (650) 498-6678

  • Lisa D. Butler PhD,

    1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.

  • Janine Giese-Davis PhD,

    1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.

  • Cheryl Koopman PhD,

    1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.

  • Elaine Miller RN, MPH,

    1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.

  • Sue DiMiceli BA,

    1. SoluGenics LLC, Palo Alto, California
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.

  • Catherine C. Classen PhD,

    1. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.

  • Patricia Fobair LCSW, MPH,

    1. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.

  • Robert W. Carlson MD,

    1. Department of Medicine/Oncology, Stanford University School of Medicine, Stanford, California
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.

  • Helena C. Kraemer PhD

    1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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    • The authors of this article contributed as follows: Dr. Spiegel had full access to all data in the study and takes responsibility for data integrity and data analysis accuracy; Study concept and design: Spiegel, Fobair, Carlson, Kraemer; Data acquisition: Spiegel, Butler, Giese-Davis, Miller, Classen, Fobair; Data analysis and interpretation: Spiegel, Giese-Davis, Butler, Koopman, DiMiceli, Carlson, Kraemer; Drafting of the manuscript: Spiegel, Butler, Giese-Davis; Critical revision of the manuscript for important intellectual content: Spiegel, Butler, Giese-Davis, Koopman, Miller, DiMiceli, Classen, Fobair, Carlson; Statistical analysis: Giese-Davis, Butler, Koopman, DiMiceli, Kraemer; Funding acquisition: Spiegel, Butler, Koopman, Giese-Davis; Administrative, technical, or material support: Miller, Carlson; Study supervision: Spiegel, Butler, Koopman, Carlson.


  • The study sponsors had no role in the design and conduct of the study, collection, management, analysis, interpretation of the data, or preparation, review, or approval of the manuscript.

  • ClinicalTrials.gov Identifier: NCT00226928. http://www.clinicaltrials.gov

  • §

    This article was presented at the annual meeting of the American Psychiatric Association, May 20, 2006, Toronto, Canada.

Abstract

BACKGROUND.

This study was designed to replicate our earlier finding that intensive group therapy extended survival time of women with metastatic breast cancer. Subsequent findings concerning the question of whether such psychosocial support affects survival have been mixed.

METHODS.

One hundred twenty-five women with confirmed metastatic (n = 122) or locally recurrent (n = 3) breast cancer were randomly assigned either to the supportive-expressive group therapy condition (n = 64), where they received educational materials plus weekly supportive-expressive group therapy, or to the control condition (n = 61), where they received only educational materials for a minimum of 1 year. The treatment, 90 minutes once a week, was designed to build new bonds of social support, encourage expression of emotion, deal with fears of dying and death, help restructure life priorities, improve communication with family members and healthcare professionals, and enhance control of pain and anxiety.

RESULTS.

Overall mortality after 14 years was 86%; median survival time was 32.8 months. No overall statistically significant effect of treatment on survival was found for treatment (median, 30.7 months) compared with control (median, 33.3 months) patients, but there was a statistically significant intervention site-by-condition interaction. Exploratory moderator analysis to explain that interaction revealed a significant overall interaction between estrogen-receptor (ER) status and treatment condition (P = .002) such that among the 25 ER-negative participants, those randomized to treatment survived longer (median, 29.8 months) than ER-negative controls (median, 9.3 months), whereas the ER-positive participants showed no treatment effect.

CONCLUSIONS.

The earlier finding that longer survival was associated with supportive-expressive group therapy was not replicated. Although it is possible that psychosocial effects on survival are relevant to a small subsample of women who are more refractory to current hormonal treatments, further research is required to investigate subgroup differences. Cancer 2007. © 2007 American Cancer Society.

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