Table 4 |
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Methods and outcomes of studies examining the effect of psychological intervention on breast cancer survival |
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| Reference |
Method |
Disease outcome |
Psychological/psychosocial factors examined |
Main findings |
|
|
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| Spiegel et al. 1989 [35] |
Patients were randomly assigned to the intervention or the control group, by a mean
of 24.4 months from first metastasis (intervention group) and 21.9 months from first
metastasis (control group). The 1 year intervention consisted of weekly supportive
group therapy, led by a psychiatrist or social worker with a therapist who had breast
cancer in remission. Groups were encouraged to discuss how to cope with cancer, express
their feelings, be more assertive with doctors. They were not led to believe that
they would live longer. Self hypnosis was taught for pain control |
At 10 years follow up only 3 patients were alive. Survival for the intervention group
was a mean of 36.6 months and for the control group survival was a mean of 18.9 months |
Participation in a psychosocial support therapy program |
Patients in the intervention group lived significantly longer (p < 0.0001, Cox). The interval from first metastasis to death was also significantly
longer (p < 0.001, Cox). |
| Gellert et al. 1993 [36] |
Support program (Exceptional Cancer Patients (EcaP)) consisted of weekly cancer peer
support and family therapy, individual counselling, and use of positive mental imagery,
meditation, and relaxation. Using data from local hospital tumour registries in 1981,
three women with breast cancer were matched to each EcaP participant regarding age
at histological diagnosis, race, stage of disease, surgery, and sequence of malignancy.
Subjects retrospectively monitored for survival time through March 1991, using records
from the State of Connecticut Tumor Registry. Two analyses were made, an unadjusted
and a restricted one. In the latter, non-participants were restricted to those who
had a survival time greater than that of the matched case at time of entry into the
support program |
Unadjusted analysis: 41% of EcaP participants survived 10 years, compared with 47%
of non-participants. Restricted analysis: 37% of non-participants survived 10 years |
Participation in a psychosocial support therapy program |
There was no significant association between psychosocial intervention and breast
cancer survival |
| Cunningham et al. 1998 [37] |
The intervention group was offered 35 2-hour weekly sessions of supportive and cognitive
behavioural therapy. Patients in the intervention group were also given 20 cognitive
behavioural assignments as homework and were encouraged to attend a weekend training
in coping skills, especially relaxation, stress management, thought monitoring, goal
setting and mental imaging. The control group received only a home study cognitive
behavioural package |
At 5 years follow up median survival on the intervention group was 28.2 months. Median
survival on the control group was 23.6 months (probably due to the longer medial interval
between metastatic diagnosis and entering the study in the control group) |
Participation in supportive plus cognitive behavioural therapy groups |
There was no significant association between psychosocial intervention and breast
cancer survival |
| Edelman et al. 1999 [38] |
Initially, 124 patients were recruited for the study, of whom 62 were randomly allocated
to the intervention group and received cognitive behaviour therapy, whereas 62 were
allocated to a standard care control group. Three patients (two from the therapy group
and one from the control group) were excluded because they did not have metastatic
disease. Patients were recruited between March 1994 and February 1997; thus, at the
time of survival analysis participants had entered the study between 2 and 5 years
previously. Of these patients, 38 had been identified through the medical records
of the Royal North Shore Hospital, Sydney; doctors at other hospitals referred 3 and
83 responded to media publicity. Demographic information from patients, medical information
from hospital records. Treating physicians completed Eastern Cooperative Oncology
Group (ECOG) Performance status and Disease Status forms at each assessment period.
Two self-report instruments for information on psychological criteria: the Profile
of Mood States and the Coopersmith Self-esteem Inventory. Assessments were conducted
prior to intervention, following intervention, and at 3 and 6 months after intervention. |
Survival time was calculated from the day of entry to the study. At the time of survival
analysis, 85 (70.2%) patients had died |
Participation in a group cognitive behavioural therapy program |
There was no significant association between psychosocial intervention and breast
cancer survival |
| Shrock et al. 1999 [39] |
Six two-hour psychology classes. Class topics: beliefs/feelings/attitudes toward health,
relaxation/imagery techniques, nutrition, exercise, stress management, self-esteem,
spirituality, receptive imagery/intuition, problem solving and personal health plan
setting. The 21 breast cancer patients who received intervention were matched with
74 breast cancer patients of the same stage. There were two to three matched controls
for each patient |
At 4 to 7 years follow up none of the intervention group had died, 12% of the control
group had died (median follow-up 4.2 years) |
Participation in health psychology classes |
The intervention control group lived significantly longer (p = 0.042) |
| Goodwin et al. 2001 [40] |
Women participating in the intervention group attended weekly meetings lasting 90
minutes. Therapy intended to foster support among members and encourage the expression
of emotions about cancer and its effects on their lives. Patients were encouraged
to attend sessions for at least 1 year. The primary outcome was survival and the secondary
psychosocial function assessed by self-report questionnaires (Profile of Mood States
and Pain Suffering Scales by Spiegel-Bloom) at baseline and at 4, 8 and 12 months |
By the time of analysis 201 patients had died. The median survival for the intervention
group was 17.9 months, and for the control group was 17.6 months |
Participation in supportive-expressive group therapy |
There was no significant association between psychosocial intervention and breast
cancer survival |
|
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Falagas et al. Breast Cancer Research 2007 9:R44 doi:10.1186/bcr1744 |
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