Support Groups Improve Survival?
This is a study that I would really love to love. Barbara Anderson, PhD and her colleagues at Ohio State University found a 59% reduced risk of dying and a 45% reduced risk of recurrence among women with breast cancer who participated in a support group. As many of you know, I love good support groups, facilitate five of them, and am convinced that, for some women, they are the best possible kind of support and understanding. However, I am sadly skeptical that participation can make an impact on physical health. On emotional health? You bet, absolutely. The importance of being with others in a similar situation, feeling understood and valued, having a safe sanctuary cannot be over-emphasized.
This reminds me, however, of the famous study by David Spiegel, MD from Stanford many years ago. Dr Spiegel studied women with Stage IV breast cancer who attended groups and found a significant survival advantage for them. However, when a number of people tried to reproduce those results at other places, they could not do so.
Here is the report on this new study. Read it with a grain of salt, but do consider joining a group. They are wonderful.
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Psychosocial Therapy Effects in Breast Cancer Questioned
By Kristina Fiore, Staff Writer, MedPage Today
June 11, 2010
Cancer experts are wary of a new study that links psychosocial interventions with improved survival in breast cancer. The study, published in Clinical Cancer Research, found a 59% reduced risk of dying from recurrent breast cancer among women involved in such interventions. But researchers warn that the study was small, and touts questionable effects on the immune system.
"I'm concerned because I think it's really misleading to breast cancer patients," said James Coyne, PhD, professor of psychiatry at the University of Pennsylvania and co-leader of the Abramson Cancer Center Cancer Control and Outcomes program, who was not involved in the study. "We only wish it were true that the mind has important influence over the body in cancer, but it doesn't,"
The study by Barbara L. Andersen, PhD, of Ohio State University, in Columbus, and colleagues is an analysis of longer-term data from a previous assessment. In 2008, they found positive psychological, social, immune, and health benefits among patients in an intervention, compared with controls. They said these patients also had a 45% reduced risk of recurrence. So the researchers wanted to see whether the intervention arm would also have longer survival. By October 2007, 62 of the original 227 patients had disease recurrence.
A total of 41 were available for analysis -- 23 in the intervention group and 18 controls.
The intervention had been conducted in groups of eight to 12 patients led by clinical psychologists. It included relaxation training, positive ways to cope with stress and cancer-related difficulties (such as fatigue), methods to maximize social support, and strategies for improving both health behaviors (such as diet and exercise) and adherence to cancer treatments. A total of 26 sessions comprising 39 therapy hours were delivered over 12 months. Patients were reassessed every four months during year one, every six months during years two to five, and annually thereafter.
Andersen and colleagues found a 59% reduced risk of death following recurrence for the intervention arm (HR 0.41, 95% CI 0.20 to 0.83, P=0.014). All patients responded with significant psychological distress at recurrence diagnosis, but thereafter only the intervention arm improved (P<0.023), and the researchers said that "after the shock of diagnosis, the
intervention arm patients may have drawn upon strategies they had learned for reducing stress and coping positively."
In terms of immune system responses, the researchers found significantly higher levels of certain biomarkers in the intervention group (natural killer cell cytotoxicity, concanavlin A blastogenesis, and phytohemagglutinin blastogenesis: P=0.001, P=0.021, and P=0.007, respectively). However, the researchers cautioned that it remains to be seen whether immunity as measured here is critical to survival of breast cancer patients.
Coyne said the immune effects seen in the study were "pretty trivial." In addition, he emphasized that researchers are unsure of the "complex role" that the immune system plays in cancer. "We don't know when it's on the side of the tumor or on the side of the patient," he said. Some aggressive tumors, for example, enlist the immune system for self-protection.
Coyne, who has conducted a review of the literature on outcomes in such interventions, added that no study that had survival as an endpoint ahead of time has ever found an effect. Also, many studies have had confounding effects from medical treatment.
For instance, patients involved in interventions may get better medical attention "because their therapist was talking to their oncologist," he said.
Alyson Moadel, PhD, of Albert Einstein College of Medicine and Montefiore Medical Center in Bronx, N.Y., conducted the first NIH-funded study of the effects of yoga on cancer patients and is involved in the center's psychosocial oncology program.
She said the current study had too small a size to generalize to the larger breast cancer population, and it also failed to measure adherence to the intervention.
"I agree that it is too preliminary to conclude that psychosocial interventions improve survival without replicating this study in a much larger sample and knowing about adherence to the intervention," she said, but added that it's not without value.
"I would say that this study offers empirical support that such interventions may go beyond promoting only quality of life," she said, "but further research is needed."
Primary source: Clinical Cancer Research
Andersen BL, et al "Biobehavioral, immune, and health benefits following recurrence for
psychological intervention participants" Clin Cancer Res 2010; 16(12); 3270-78.