Cancer Group Therapy Adds To Well-Being, Not Longevity

“What this study teaches us is that if you are well-supported socially, and if you are coping well and don’t have a high degree of psychological stress, you don’t need to do this group,” Leszcz said. “But if you are stressed, you can count on being significantly and meaningfully helped.”

That’s crucial, Leszcz pointed out, because in the wake of studies suggesting that psychosocial support groups could extend life, some patients may have felt compelled to participate. “What it does is give choice back to people,” he noted. “It removes the potential that people might feel a desperate need to get into this. Not everyone is interested in support groups.”

The value of choice for women with breast cancer was also stressed by patient groups responding to news about the study.

“We believe that these findings are not surprising, and we will continue to reinforce psychosocial support as an option for improving a patient’s quality of life,” said Rebecca Garcia, Ph.D., vice president of health sciences for the Susan G. Komen Breast Cancer Foundation, in response to the NEJM report. “The Komen Foundation feels that it is important for women to have a wide variety of support options when facing a breast cancer diagnosis and will continue to empower patients to make their own choices as to how to find the support they need during this time.”

Spiegel told Psychiatric News that recent improvements in medical treatment of breast cancer may have raised the ceiling of survival, making it that much harder to demonstrate a survival benefit with psychotherapy. And some of those treatments, including new selective, estrogen-receptor modulators, appear also to affect the same stress-related hormone systems that psychosocial support may act on.

Spiegel stated that the entire arena of psychological treatment of breast cancer patients has improved markedly since his 1989 study. Then, it was difficult to recruit women to participate in psychosocial support groups; today, just the opposite is true, he said.

The “supportive-expressive” group therapy utilized in the new study is modeled on a protocol standardized by Spiegel for use with women having metastatic breast cancer—a disease with an average survival of two and a half years. Led by a professional therapist, the groups allow women to confront existential issues in a supportive atmosphere.

Spiegel said that the success of such groups at improving psychological health—if not always improving survival—has shattered the notion that life-threatening illness must be met with denial and a smile.

“When these groups were started in the 1970s, there was an assumption that we would make people worse by having them confront their own mortality,” he observed. “It is extremely clear that that is not the case. Facing one’s own death and the death of another can be a growth experience, not a demoralizing one.”

Leszcz agreed that the model of psychosocial support championed by Spiegel has sprung open the “prison of positive thinking” many patients with life-threatening illness feel confined by.

“Rather than facilitate denial, we wanted to create an environment in which women would be able to meaningfully confront their concerns, support each other, and develop coping strategies,” he said. ▪