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The effect of psychosocial intervention on time of survival of 86 patients with metastatic breast cancer was studied prospectively. The 1 year intervention consisted of weekly supportive group therapy with self-hypnosis for pain. Both the treatment (n = 50) and control groups (n = 36) had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival from time of randomisation and onset of intervention was a mean 36.6 (SD 37.6) months in the intervention group compared with 18.9 (10.8) months in the control group, a significant difference. Survival plots indicated that divergence in survival began at 20 months after entry, or 8 months after intervention ended.
Many studies have demonstrated positive psychosocial effects of group therapy in cancer patients, including improvements in mood, adjustment, and pain. However, few studies have prospectively examined medical effects. In general, patients who receive psychotherapy survived longer. Our objective was to assess whether group therapy in patients with metastatic breast cancer had any effect on survival. This group intervention has been reported to improve the psychological well-being of such patients. We started with the belief that positive psychological and symptomatic effects could occur without affecting the course of the disease; we expected to improve the quality of life without affecting its quantity. Here we describe a 10 year follow-up of the effect of psychosocial intervention on disease progression and mortality.
Patients and methods
Only subjects with documented metastatic carcinoma of the breast were included. 109 women were referred by their oncologists. Those patients who agreed were called upon by our research interviewer, who told them about the study and invited them to participate. Of this group, 86 completed the first questionnaire, while 18 others refused to participate and 5 died before contact. After written informed consent was obtained (protocol approved by Stanford Human Subjects Committee), a battery of psychological tests was administered. The subjects were then randomly assigned to either the intervention or control groups, and initial follow-up was done every 4 months for a year. More subjects were randomly assigned to therapy (n = 50) than to control (n = 36) to ensure enough patients for group work.
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