Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial.
BACKGROUND
Mixed reports exist about the impact of supportive-expressive group therapy (SEGT) on survival.


METHODS
From 485 women with advanced breast cancer recruited between 1996-2002, 227 (47%) consented and were randomized within an average 10 months of cancer recurrence in a 2:1 ratio to intervention with 1 year or more of weekly SEGT plus three classes of relaxation therapy (147 women) or to control receiving three classes of relaxation therapy (80 women). The primary outcome was survival; psychosocial well-being was appraised secondarily. Analysis was by intention-to-treat.


RESULTS
SEGT did not prolong survival (median survival 24.0 months in SEGT and 18.3 in controls; univariate hazard ratio for death 0.92 [95% CI, 0.69-1.26]; multivariate hazard ratio, 1.06 [95% CI, 0.74-1.51]). Significant predictors of survival were treatment with chemotherapy and hormone therapy (p<0.001), visceral metastases (p<0.001) and advanced disease at first diagnosis (p<0.05). SEGT ameliorated and prevented new DSM-IV depressive disorders (p = 0.002), reduced hopeless-helplessness (p = 0.004), trauma symptoms (p = 0.04) and improved social functioning (p = 0.03).


CONCLUSIONS
SEGT did not prolong survival. It improved quality of life, including treatment of and protection against depression.
Kissane
David W
DW
Department of Psychiatry and Behavioural Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. kissaned@mskcc.org
Grabsch
Brenda
B
Clarke
David M
DM
Smith
Graeme C
GC
Love
Anthony W
AW
Bloch
Sidney
S
Snyder
Raymond D
RD
Li
Yuelin
Y
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000401:mortality / Q000523:psychology / Q000628:therapy; D017281:Cost of Illness; D003865:Major Depressive Disorder / Q000209:etiology* / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019260:Expressed Emotion; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000523:psychology / Q000556:secondary / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary / Q000401:mortality / Q000523:psychology; D010349:Patient Compliance / Q000706:statistics & numerical data; D011584:Psychology; D011615:Psychotherapy, Group / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D012064:Relaxation Therapy; D012720:Severity of Illness Index; D012944:Social Support; D015996:Survival Rate