A new US study that follows up on a previous study that suggested otherwise, shows that group therapy does not prolong the lives of women with metastatic breast cancer. However, it did find that group therapy prolonged survival and improved quality of life for women with estrogen receptor (ER) negative tumours.

The study will be available online later today in the journal Cancer, the printed edition will be out on 1st September.

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.

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.

The research is the work of Prof David Spiegel and colleagues. Spiegel is Professor of Psychiatry and Behavioural Science at the Stanford Comprehensive Cancer Center at Stanford University School of Medicine in California, and his research interests cover mind-body medicine such as how the mind controls body functions, including progress of diseases such as cancer, response to traumatic stress and perception of pain and anxiety.

In 1989 Spiegel published a paper in the Lancet (ii:888-891) that suggested group psychotherapy for women with metastatic breast cancer prolonged survival. The study showed that women who had group therapy for one year were more likely to survive another 18 months after diagnosis compared with patients who did not have group therapy. Four subsequent studies supported this finding while six of them did not.

This latest study is an attempt to replicate the earlier study in a new randomized, case-controlled prospective trial. Spiegel and colleagues randomly assigned 125 patients to one of two groups. One group (61 patients) received educational literature for one year and the other group (64 patients) received educational literature and attended weekly group psychotherapy for a year. Both groups had the same type of medical treatment for their metastatic breast cancer.

They found no difference in the overall survival between the two groups. The patients who had group therapy survived for a median duration of 31 months, compared with 33 months in the education literature only group.

However, further analysis showed a survival benefit from group therapy for women with ER-negative tumours. The median survival for patients with ER-negative breast cancer was 21 months longer than for the group that received literature only (30 versus 9 months).

There was no increase in survival for women with ER-positive tumours. ER-positive tumours do however respond to improved hormonal treatments such as aromatose inhibitors.

Commenting on this latest finding, Spiegel and colleagues said that while there was no overall benefit on survival due to group therapy for women with metastatic breast cancer, there were psychological benefits in other ways.

“Being confronted with their ‘worst fears’ as they see others die of the same illness, with help in managing the strong emotions that understandably arise, is emotionally helpful for patients and not physically harmful,” wrote the authors.

According to the American cancer Society, 178,000 women in the US will be diagnosed with invasive breast cancer this year and nearly 40,500 will die from it. There are currently over 2 million women living with breast cancer in the US who have received treatment for it.

The chance of a woman having invasive breast cancer at some point in her life is about 1 in 8, and the chance of dying from it is about 1 in 33.

Breast cancer is the most common cancer in women, second to skin cancer, and it is the leading cause of cancer death in women after lung cancer.

The good news is that deaths due to breast cancer are going down; probably because of two things: early diagnosis and better treatments.

“Effects of Supportive-Expressive Group Therapy on Survival of Patients with Metastatic Breast Cancer: A Randomized Prospective Trial.”
David Spiegel, Lisa D. Butler, Janine Giese-Davis, Cheryl Koopman, Elaine Miller, Sue DiMiceli, Catherine C. Classen, Patricia Fobair, Robert W. Carlson, Helena C. Kraemer.
Cancer Published Online: July 23, 2007
DOI: 10.1002/cncr. 22890
Print Issue Date: September 1, 2007.

Click here for Cancer journal home page.

Click here for American Cancer Society.

Written by: Catharine Paddock
Writer: Medical News Today