title: Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: a randomized prospective trial.
abstract: BACKGROUND
  This study was designed to replicate our earlier finding that intensive group therapy extended survival time of women with metastatic breast cancer. Subsequent findings concerning the question of whether such psychosocial support affects survival have been mixed.
  
  
  METHODS
  One hundred twenty-five women with confirmed metastatic (n = 122) or locally recurrent (n = 3) breast cancer were randomly assigned either to the supportive-expressive group therapy condition (n = 64), where they received educational materials plus weekly supportive-expressive group therapy, or to the control condition (n = 61), where they received only educational materials for a minimum of 1 year. The treatment, 90 minutes once a week, was designed to build new bonds of social support, encourage expression of emotion, deal with fears of dying and death, help restructure life priorities, improve communication with family members and healthcare professionals, and enhance control of pain and anxiety.
  
  
  RESULTS
  Overall mortality after 14 years was 86%; median survival time was 32.8 months. No overall statistically significant effect of treatment on survival was found for treatment (median, 30.7 months) compared with control (median, 33.3 months) patients, but there was a statistically significant intervention site-by-condition interaction. Exploratory moderator analysis to explain that interaction revealed a significant overall interaction between estrogen-receptor (ER) status and treatment condition (P = .002) such that among the 25 ER-negative participants, those randomized to treatment survived longer (median, 29.8 months) than ER-negative controls (median, 9.3 months), whereas the ER-positive participants showed no treatment effect.
  
  
  CONCLUSIONS
  The earlier finding that longer survival was associated with supportive-expressive group therapy was not replicated. Although it is possible that psychosocial effects on survival are relevant to a small subsample of women who are more refractory to current hormonal treatments, further research is required to investigate subgroup differences.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5718, USA. dspiegel@stanford.edu
authors.forename: David
authors.initials: D
authors.lastname: Spiegel
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Butler
authors.forename: Janine
authors.initials: J
authors.lastname: Giese-Davis
authors.forename: Cheryl
authors.initials: C
authors.lastname: Koopman
authors.forename: Elaine
authors.initials: E
authors.lastname: Miller
authors.forename: Sue
authors.initials: S
authors.lastname: DiMiceli
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Classen
authors.forename: Patricia
authors.initials: P
authors.lastname: Fobair
authors.forename: Robert W
authors.initials: RW
authors.lastname: Carlson
authors.forename: Helena C
authors.initials: HC
authors.lastname: Kraemer
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011379:Prognosis; D011446:Prospective Studies; D011615:Psychotherapy, Group / Q000379:methods*; D013997:Time Factors