Group therapy doesn’t prolong life of breast cancer patients

26 July, 2007:

Repudiating an old belief, new research has found that group therapy does not prolong the lives of women with advanced cases of breast cancer.

The new study, conducted in the United States, followed up on a previous study that suggested group therapy does prolong the lives of women with metastatic breast cancer.

Metastatic breast cancer is cancer that started in the breast and has spread to other parts of the body, such as the lungs and bones. It is an advanced stage of cancer and much harder to treat than one that has not yet spread.

However, the latest study, available online in the journal Cancer, found that group therapy prolonged survival and improved quality of life for women with estrogen receptor (ER) negative tumours.

Estrogen receptor (ER) negative breast cancer is a type that does not thrive in an estrogen-rich environment and therefore does not respond to anti-estrogen hormone therapy.

A landmark study held in 1989 had shown that group therapy doubled the survival time of women with metastatic breast cancer. That conclusion had given rise to a large number of cancer support groups and fuelled a debate about the effect of such therapy on the course of cancer.

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

The latest study, he warned, should not discourage cancer patients from joining support groups, which have become an accepted part of cancer care. The groups encourage participants to express fears, anger and depression; confront their doctors; and grieve for those in the group who have died.

However, 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.

Dr David Kissane, chairman of psychiatry and behavioral sciences at Memorial SloanKettering 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. It does not,” he said.

Spiegel undertook the latest study to confirm his older report. Other researchers have attempted to replicate his findings, with conflicting results.

According to Spiegel, many of the life-extending drugs used to treat breast cancer today were not available when he began his first study in the 1970s. The drugs leave “less room for improvement” through group therapy, he said.

Society, he added, has become more accepting of cancer, making it possible for patients to find social and emotional support outside group therapy. So the effect of such therapy may be less powerful today than 30 years ago when “cancer was a dirty word; when people saw it as a death sentence, and they suffered in silence.”

Mitch Golant, a psychologist and vice-president of research and development for the Wellness Community, a Washington-based non-profit organisation that sponsors support groups, said he did not expect the latest study to affect participation in support groups. He explained: “The number one reason why people join support groups is because they want to be with others who are going through what they are going through.”