Finding what is not there

Unwarranted claims of an effect of psychosocial intervention on recurrence and survival


  • Michael E. Stefanek PhD,

    Corresponding author
    1. American Cancer Society, Behavioral Research Center, Atlanta, Georgia
    • Vice President, Behavioral Research and Director, Behavioral Research Center, American Cancer Society, 250 Williams Street, NE, Atlanta, GA 30303===

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    • Fax: (404) 728-0856

  • Steven C. Palmer PhD,

    1. LIVESTRONG Survivorship Center of Excellence, Cancer Control, and Outcomes, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Brett D. Thombs PhD,

    1. Department of Psychiatry, McGill University, Montreal, Quebec, Canada
    2. Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada
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  • James C. Coyne PhD

    1. Behavioral Oncology Program, Abramson Cancer Center and Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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  • See also pages 5617-9, this issue.


In a recently published randomized trial, Andersen et al. claimed to observe a reduced risk of recurrence and improved survival among women with early stage breast cancer who were assigned to a psychological intervention versus an assessment-only group. Anderson et al. concluded that “psychological intervention, as delivered and studied here, can improve survival.” The current commentary challenges that conclusion on methodological and statistical grounds, noting that the study by Andersen et al. was not designed to assess survival and used methods that capitalized on chance, making it highly unlikely that their claims could be replicated. No other study designed to assess whether psychosocial intervention provides a survival benefit for cancer patients has ever demonstrated such an effect; and, currently, there is no support for the hypothesis that survival benefits can be attributed to psychosocial intervention. The authors of this commentary argue that much needs to be learned at the more basic biobehavioral level about the impact of stress or psychological factors on tumor biology before even considering whether large clinical trials are warranted. In addition, making the claim that psychological interventions improve survival is not evidence-based, is potentially harmful, and detracts from the potential significant benefits of psychological interventions related to quality of life. Cancer 2009. © 2009 American Cancer Society.