A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer

In order to test the effect of a psychological intervention on survival fro m cancer, 66 women with metastatic breast cancer, all receiving standard me dical care, were randomly assigned into two groups; one group (n = 30) atte nded the psychological intervention, consisting of 35 weekly, 2 h sessions of supportive plus cognitive behavioral therapy; the control group (n = 36) received only a home study cognitive behavioral package. No significant di fference was found in survival post-randomization between the groups as ass essed by a log rank test 5 years after the commencement of the study. As ex pected, several prognostic factors were significant predictors of survival: metastatic site, hormonal receptor status, and chemotherapy prior to rando mization. While many personal and demographic variables did not influence s urvival, there was a significant effect of self-reported exercise (possibly due to better health). A small subgroup of intervention subjects who atten ded outside support groups also survived significantly longer than those wh o did not. The strengths and limitations of the present study are discussed, and the r esults contrasted with those of a well known study by Spiegel et al. (Spieg el, D., Bloom, J.R., Kraemer, H.C. and Gottheil, E. (1989) Lancet ii, 888-8 91). We propose that a different experimental design (correlative) may be n eeded to show any effect of self-help behaviors and psychological attribute s in a small minority of patients. (C) 1998 John Wiley & Sons, Ltd.