SAN FRANCISCO—For patients with metastatic breast cancer, adding weekly group therapy to standard care does not appear to improve survival, although psychological and other benefits are seen in certain patients, according to results of a multicenter, randomized, controlled Canadian trial.
"The addition of supportive-expressive group therapy to standard care in women with metastatic breast cancer does not result in prolonged survival," said Pamela J. Goodwin, MD, associate professor of medicine, University of Toronto. "But it does result in modestly improved mood in women who are experiencing psychological distress, and modestly improved pain control in women who are experiencing pain."
Dr. Goodwin reported results of the Breast Expressive-Supportive Therapy (BEST) study, funded by the Medical Research Council of Canada and the Canadian Breast Cancer Research Initiative, at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO abstract 79) (The article has since been published: N Engl J Med 345:1719-1726, 2001.)
Suspicion that group psychosocial support might actually prolong survival in metastatic breast cancer arose following an unexpected observation in a previous trial. Spiegel et al (Lancet 2:888-889, 1989) reported that women who received supportive-expressive group therapy lived, on average, twice as long as those who did not. Since then, other studies have examined survival effects of psychosocial interventions in cancer, and results have been inconsistent.
To determine the effects of weekly expressive-supportive therapy on survival, Canadian investigators at seven centers randomized 235 metastatic breast cancer patients (mean age, 50.2 years; mean of 20.4 months since first metastasis) in a 2:1 fashion to weekly 90-minute support group sessions led by a therapist or to a control arm. All women received standard medical or psychosocial care as needed.
Sessions were designed to foster social integration, encourage emotional expressiveness, enhance coping strategies, and promote self-hypnosis and relaxation skills. Two trained and experienced leaders coordinated each session.
With median follow-up of about 4 years, median survival in the two arms was similar (17.9 months for the intervention group vs 17.6 months for controls, P = .72), with no evidence that the result was influenced by variables including study center, baseline psychological stress, or marital status.
