Breast Cancer Support Groups Don't Prolong Life

But study shows sessions ease pain and strain

WEDNESDAY, Dec. 12, 2001 (HealthDayNews) -- Women with advanced breast cancer don't live longer if they participate in group therapy to discuss their illness, a new study says. But they do report feeling less pain and emotional strain than women who don't attend the sessions.

Some evidence has suggested that group therapy can prolong survival in patients with melanoma and colon cancer. And a 1989 report showed that women with metastatic breast cancer in the 1970s lived 18 months longer if they received such counseling.

Yet the latest work adds to a string of more recent studies that have failed to link group therapy with improved survival, at least for advanced breast disease. The findings appear in the Dec. 13 issue of The New England Journal of Medicine.

A research team, led by Dr. Pamela J. Goodwin of Mount Sinai Hospital at the University of Toronto, compared mortality rates in 235 women with aggressive breast tumors. Two-thirds of the women received a form of group counseling called "supportive-expressive" therapy.

The weekly sessions, which were designed to include 10 to 12 women -- though illness often kept many of them away -- provided patients a forum to vent their anger, fears and frustrations about their conditions. The therapy also helped patients improve their relationships with family and friends and learn ways of coping with their disease.

Women who attended the support groups lived about 18 months, on average, compared with 17.6 months for those who didn't go, a statistically insignificant difference, the researchers say.

But those who went to therapy reported feeling more emotionally at ease throughout the study. They had less hostility, depression and anxiety than those who didn't go. Moreover, the effects were strongest for women who initially were most distressed.

Goodwin says they also reported less pain from their disease because they got more encouragement to take full advantage of pain medication.

"There was a lot of discussion of pain control and fear of addiction, and through those discussions they were encouraged to take as much pain medication as they could," Goodwin says. Even so, she says, "It doesn't matter that that's the mechanism. It still helped the women get better pain control."

Dr. Thomas Wise, professor of psychiatry at Johns Hopkins University, in Baltimore, and editor of the journal Psychosomatics, says it's "wishful thinking that we can intervene in mind over matter. Sadly, things are not that simple."

But even if group therapy doesn't add months or years to a patient's prognosis, "it's still a very powerful intervention to make people feel better. One of the biggest problems people have with serious disease is saying, 'I know you're not going to know how I feel,'" Wise says. Yet with counseling, that barrier disappears.

Sally Cooper, a spokeswoman for the National Alliance of Breast Cancer Organizations, in New York City, says the lack of any survival benefit from support groups should in no way discourage women with advanced breast cancer from joining the sessions.

"It's a transformative experience for people to be in support groups," Cooper says. "Getting good support to help with a terminal diagnosis is extraordinarily important to anyone."

However, she says the danger with continuing to look for an effect on mortality is that failing to find one might deter some doctors from recommending support to their patients, as well as making insurance coverage for those sessions more difficult.

Although there's no good estimate of how many women with metastatic breast disease do seek group therapy, Cooper says she knows of only about 20 such programs nationwide, as well as a smattering of online networks.

What To Do

The American Cancer Society estimates that 192,000 women in this country will develop breast cancer, and about 40,600 will die from the disease this year.

To read more about the illness, visit the American Cancer Society.

To find out how to contact a breast cancer support group, try the National Alliance of Breast Cancer Organizations.

SOURCES: Interviews with Pamela J. Goodwin, M.D., senior scientist, Mount Sinai Hospital, University of Toronto; Thomas N. Wise, M.D., professor of psychiatry and behavioral sciences, Johns Hopkins University, Baltimore; Sally Cooper, spokeswoman, National Alliance of Breast Cancer Organizations, New York City; Dec. 13, 2001, The New England Journal of Medicine
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