Can Psychological Interventions Increase Survival In Breast Cancer?

Can Psychological Interventions Increase Survival In Breast Cancer?

Tulips

Jana Bolduan Lomax, PsyD

10/01/2014

We know intuitively and anecdotally that relaxation and stress management interventions can help us to improve our ability to cope with life’s stressors, even cancer, and can certainly help with pain management and with overall quality of life in the face of cancer diagnosis and treatment. However, the longstanding question in the psycho-oncology and integrative oncology communities has been:

Can psychological interventions increase cancer survival?

Below is the summary from the National Institutes of Health/National Cancer Institute website:

http://www.cancer.gov/cancertopics/pdq/supportivecare/adjustment/HealthProfessional/page6#Section_515

The intriguing question of whether participation in a psychosocial group intervention can result in increased survival has been investigated since 1989. The original study [20] tested a supportive-expressive group therapy format for women with metastatic breast cancer, while another study [21] tested a psychoeducational group intervention for patients with malignant melanoma. In both of these studies, a survival advantage was found in the intervention group. However, a critique of the first study [22] found that members of the control group had significantly shorter survival times than would have been expected, when compared with data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, suggesting that the survival advantages may have resulted from inadvertent sampling errors.

Attempts to replicate the supportive-expressive group therapy findings were made in Canada,[23] the United States,[24] and Australia.[25] Although all three studies found significant psychological benefits, no study could replicate the survival benefit.

Literature reviews, including three meta-analyses [2628] and one systematic review,[29] have concluded that previous research has failed to find an effect of psychotherapy on survival. One summary [30] reported on ten additional randomized controlled trials of various psychosocial interventions for patients with various types of cancers (although most were women with breast cancer). All ten studies noted improved psychosocial benefits. However, nine of the ten showed no significant differences in survival, while one [31] found a survival advantage of about 1 year. This one positive trial was able to stratify groups on a number of important variables (e.g., nodal status, estrogen receptor and progesterone receptor status, and menopausal status) and provided data in support of possible mechanisms such as enhanced immune functioning and patient compliance with stress reduction procedures. In an analysis of results, this study identified the complexity of factors involved in any survival benefit and the possibility that immune system-mediated benefits may contribute to increased survival, when other factors are carefully taken into account.

In summary, the preponderance of evidence indicates that despite evidence of improved quality of life, it seems unlikely that a psychosocial intervention has much chance of showing an independent contribution to survival time. This evidence has caused some to suggest [32] that continued research into this question is no longer warranted.

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