Breast Cancer Patients who get Group Therapy Live Longer

David Spiegel, M.D. of Stanford University stunned the world in 1989 when he revealed that certain therapy groups may help breast cancer patients life longer.  These groups also seem to help them live better.  By now you have probably heard of Spiegel's landmark research that showed that women with metastatic breast cancer who participated in professionally led support groups lived twice as long those who didn't participate in the groups.  Spiegel started out to prove that longevity wouldn't be affected by the groups, but that patients' quality of life would be improved.  He provided what he now calls "supportive-expressive group therapy" to 50 women with metastatic breast cancer, while 36 control patients were randomly assigned to receive only the standard oncological therapy that all participants received.  Spiegel's approach included self-hypnosis training as well as traditional group therapy techniques.  He reported that patients in the experimental group also experienced 50% less pain.  Control subjects lived an average of 18.9 months, while those receiving group therapy lived 36.6 months.

The sessions became a time and a place for women to express some of their deepest fears.

Spiegel's approach to support groups is a far cry from "positive thinking."  Participants in his program expressed their emotions openly.  Spiegel describes the groups this way:

The support groups we formed offered far more than hand-holding and good wishes.  The sessions became a time and a place for women to express some of their deepest fears, what one called "that sense of waking up at three in the morning with an elephant sitting on your chest."  She added "I wonder if I will live to see my son graduate from high school or my daughter get married.  I have to keep up a front everywhere else - that's so hard."

There was a good deal of crying in these groups, as well as laughter.  One of the concerns about getting patients with similar illnesses together is that they will become demoralized if members get sicker or die.  To find out if this is so, we compared those group sessions in which there was bad news about a group member to those in which the group was doing well.  We found that the women were not scared about each other's medical problems because the risk of dying was something that each one worried about anyway.  Rather, the groups provided a setting in which they could deal with their fears. (Spiegel, 1993)    

In the fall of 1990 he began this ten year project to replicate the original findings.  His team describes their replication project this way:

The specific aims of the study are:

1. To study the effect of group psychotherapy on survival time of patients with metastatic breast cancer.
2. To assess the physiological basis of psychosocial effects on survival.
3. To examine psychosocial effects of group treatment.
4. To determine pre-existing psychosocial and physiological variables that are predictors of survival time.
5. To determine the relationship between changes in psychosocial variables and survival time.
6. To study the effects of group therapy on health care utilization and costs.

One-hundred twenty-five women with metastatic breast cancer entered the study between 1991 and 1996. Study participants were randomly assigned to either a weekly support group plus educational materials or to receive educational materials without a support group. All women in the study are offered educational materials at each follow-up session. Assessments are conducted every six months and include measures of mood, social support, pain, sleep, diet, and exercise, as well as measures of immune and endocrine function. (Spiegel: Online quoted 10/00)

The early results are equally intriguing.  In a recent article his team reported that women with abnormal patterns of daytime cortisol secretion died sooner than other women.  Cortisol is a "stress hormone" that helps us cope with stressful situations, while also taking a toll on our immune systems. 

I have yet to see the full results from Spiegel's replication of the original 1989 study.  The  results were expected to be published soon, but his team recently announced that they are seeking funding to extend their study an additional five years.  Does this mean that some of the women who joined the study in 1996 are still alive?  Or is the team recruiting additional subjects?  You can get the latest information at Spiegel's Stanford Web site.

If you suffer from metastatic breast cancer there is a good chance that you can improve your life, and maybe even extend it, by joining a professionally led support/therapy group that uses Spiegel's "supportive-expressive" model.  If you can't find a group that uses that model, then just join a support group.  It seems to help to talk about how you feel - even when you feel really hopeless.  Rather than attempt to cure cancer with positive thinking, David Spiegel and his colleagues are proving that you can improve and extend life by sharing the good and the bad with others.    

Stanford School of Medicine Psychosocial Treatment Laboratory

July 2000 Press Release - Cortisol Study

Abstract of the current study

Supportive-Expressive Group Therapy Training Manual (order it Online)

History of Depression linked to Breast Cancer Risk - from Doctor's Guide

What do you think?

References

Spiegel, D., Bloom, J.R., & Gottheil, E. "Effects of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer." Lancet, 2(1989): 888-891. 

Spiegel, D. "Social Support: How Friends, Family, and Groups Can Help." in Mind Body Medicine, Golrman, D. & Gurin, J. Consumer Report Books, 1993.

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