Background: Supportive-expressive group therapy has been reported to prolon
g survival among women with metastatic breast cancer. However, in recent st
udies, various psychosocial interventions have not prolonged survival.
Methods: In a multicenter trial, we randomly assigned 235 women with metast
atic breast cancer who were expected to survive at least three months in a
2:1 ratio to an intervention group that participated in weekly supportive-e
xpressive group therapy (158 women) or to a control group that received no
such intervention (77 women). All the women received educational materials
and any medical or psychosocial care that was deemed necessary. The primary
outcome was survival; psychosocial function was assessed by self-reported
questionnaires.
Results: Women assigned to supportive-expressive therapy had greater improv
ement in psychological symptoms and reported less pain (P=0.04) than women
in the control group. A significant interaction of treatment-group assignme
nt with base-line psychological score was found (P less than or equal to0.0
03 for the comparison of mood variables; P=0.04 for the comparison of pain)
; women who were more distressed benefited, whereas those who were less dis
tressed did not. The psychological intervention did not prolong survival (m
edian survival, 17.9 months in the intervention group and 17.6 months in th
e control group; hazard ratio for death according to the univariate analysi
s, 1.06 [95 percent confidence interval, 0.78 to 1.45]; hazard ratio accord
ing to the multivariate analysis, 1.23 [95 percent confidence interval, 0.8
8 to 1.72]).
Conclusions: Supportive-expressive group therapy does not prolong survival
in women with metastatic breast cancer. It improves mood and the perception
of pain, particularly in women who are initially more distressed. (N Engl
J Med 2001;345:1719-26.) Copyright (C) 2001 Massachusetts Medical Society.