Thursday, December 02, 2021

Every cancer patient benefits from social support. The interactions with relatives—parents, children, siblings—and especially with spouses and significant others, as well as with friends and clergymen, can provide emotional and physical help. Not only does this make coping with cancer easier and improve quality of life, it may also actually increase survival.

David Spiegel is a psychiatrist in California who practices at Stanford. He is the son of Herbert Spiegel, himself a famous psychiatrist known for his studies on hypnosis in therapy. Spiegel apparently developed an interest early in his career in providing stress relief and emotional support for patients with cancer. He believed that a good vehicle for doing this was support groups. These are groups of around 10 patients who have the cancer of interest who meet on a regular basis, usually led by a health professional. The participants are a mix of new and old patients, and they share their experiences, fears and hopes with others going through the same experience and hopefully reduce stress.

In 1979, Spiegel and his colleagues randomized 86 women with metastatic breast cancer, 50 to an intervention group and 36 to a control group. Those in the intervention group were assigned to support groups. As the paper (published in 1981) states, they served as role models for each other and they could talk freely with each other about their fears about mortality. The study hypothesized that those in the intervention group would have less anxiety and stress, be less depressed and be less fearful. As it turned out, at one year of follow-up, those in the intervention group did have improved vigor, decreased psychological deterioration, and an improved ability to deal with their overall predicament.

Time passed. During the 1980s, a pediatric surgeon by the name of Bernie Siegel became enormously popular as an advocate for the benefits of a positive attitude, social support and humor as all being able to increase survival for cancer, AIDS and other diseases. He appeared on all the talk shows and published several books, notably “Love, Medicine and Miracles” in 1986, which became a huge bestseller. I recall seeing patients frequently holding his book, similar to the way many mothers have a copy of Brazelton’s book on baby care.

While Spiegel agreed that social support and group therapy could improve quality of life and psychological well-being, he disagreed that it could prolong survival as suggested by Siegel. To address this, he went back to his 1981 study to investigate in the randomized trial whether the group supportive therapy had an impact on survival outcomes. The results, published in a landmark paper in The Lancet in 1989, created a firestorm. Follow-up of the supportive therapy intervention group for the intervening 10 years showed an average survival of 36.6 months versus 18.9 months for the control group, almost double. Three women were still alive of the original 86 women in the study, all in the intervention group.

It seems from his later writings that Spiegel did become a believer in the beneficial effects of group therapy on survival—you have to believe your own data. Nonetheless, good scientist that he was, he set out to replicate the findings, as was appropriate. This took a while, but the repeat study was finally published in 2007. The study randomized 125 women with metastatic breast cancer. The intervention group (n=64) received weekly group supportive therapy while the control group (n=61) did not. After 14 years of follow-up, the intervention group had a median survival of 30.7 months versus 33.3 months for the control group.

Importantly, another study investigated the impact of group supportive therapy on 303 women with localized breast cancer undergoing adjuvant therapy to determine whether in that setting it would ameliorate survival. Again, there was no improvement in outcomes. At least two other studies of group therapy in advanced breast cancer have also proved negative.

My sense is that Spiegel still adheres to his original results in the Lancet paper and believes that it is the world of oncology that has changed. By the time the later studies were conducted, treatments for breast cancer had dramatically improved and thus whatever positive effects group therapy could bring to bear on survival were drowned out by the newer therapies. He also argues that back in the late 1970s, there was still a major stigma to having and being treated for cancer. Therefore, the women he dealt with then had special benefit from the support groups as it was more difficult for them to share their diagnoses and experiences with others.

With the passage of time, people can now be more open about their diagnoses and share their feelings with others. Thus, support groups have a decreased impact at the present time (thankfully, I suppose).

Many institutions do continue to make support groups available for their patients with cancer and it seems to be a useful tool for many. Clearly, it can enhance quality of life. Whether it can increase survival remains dubious.

Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.

This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.

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