Table 4 Methods and outcomes of studies examining the effect of psychological intervention on breast cancer survival

Spiegel et al. 1989 [35]

Patients were randomly assigned to the intervention or the control group, by a mean of 24.4 months from first metastasis (intervention group) and 21.9 months from first metastasis (control group). The 1 year intervention consisted of weekly supportive group therapy, led by a psychiatrist or social worker with a therapist who had breast cancer in remission. Groups were encouraged to discuss how to cope with cancer, express their feelings, be more assertive with doctors. They were not led to believe that they would live longer. Self hypnosis was taught for pain control

At 10 years follow up only 3 patients were alive. Survival for the intervention group was a mean of 36.6 months and for the control group survival was a mean of 18.9 months

Participation in a psychosocial support therapy program

Patients in the intervention group lived significantly longer (p < 0.0001, Cox). The interval from first metastasis to death was also significantly longer (p < 0.001, Cox).

Gellert et al. 1993 [36]

Support program (Exceptional Cancer Patients (EcaP)) consisted of weekly cancer peer support and family therapy, individual counselling, and use of positive mental imagery, meditation, and relaxation. Using data from local hospital tumour registries in 1981, three women with breast cancer were matched to each EcaP participant regarding age at histological diagnosis, race, stage of disease, surgery, and sequence of malignancy. Subjects retrospectively monitored for survival time through March 1991, using records from the State of Connecticut Tumor Registry. Two analyses were made, an unadjusted and a restricted one. In the latter, non-participants were restricted to those who had a survival time greater than that of the matched case at time of entry into the support program

Unadjusted analysis: 41% of EcaP participants survived 10 years, compared with 47% of non-participants. Restricted analysis: 37% of non-participants survived 10 years

Participation in a psychosocial support therapy program

There was no significant association between psychosocial intervention and breast cancer survival

Cunningham et al. 1998 [37]

The intervention group was offered 35 2-hour weekly sessions of supportive and cognitive behavioural therapy. Patients in the intervention group were also given 20 cognitive behavioural assignments as homework and were encouraged to attend a weekend training in coping skills, especially relaxation, stress management, thought monitoring, goal setting and mental imaging. The control group received only a home study cognitive behavioural package

At 5 years follow up median survival on the intervention group was 28.2 months. Median survival on the control group was 23.6 months (probably due to the longer medial interval between metastatic diagnosis and entering the study in the control group)

Participation in supportive plus cognitive behavioural therapy groups

There was no significant association between psychosocial intervention and breast cancer survival

Edelman et al. 1999 [38]

Initially, 124 patients were recruited for the study, of whom 62 were randomly allocated to the intervention group and received cognitive behaviour therapy, whereas 62 were allocated to a standard care control group. Three patients (two from the therapy group and one from the control group) were excluded because they did not have metastatic disease. Patients were recruited between March 1994 and February 1997; thus, at the time of survival analysis participants had entered the study between 2 and 5 years previously. Of these patients, 38 had been identified through the medical records of the Royal North Shore Hospital, Sydney; doctors at other hospitals referred 3 and 83 responded to media publicity. Demographic information from patients, medical information from hospital records. Treating physicians completed Eastern Cooperative Oncology Group (ECOG) Performance status and Disease Status forms at each assessment period. Two self-report instruments for information on psychological criteria: the Profile of Mood States and the Coopersmith Self-esteem Inventory. Assessments were conducted prior to intervention, following intervention, and at 3 and 6 months after intervention.

Survival time was calculated from the day of entry to the study. At the time of survival analysis, 85 (70.2%) patients had died

Participation in a group cognitive behavioural therapy program

There was no significant association between psychosocial intervention and breast cancer survival

Shrock et al. 1999 [39]

Six two-hour psychology classes. Class topics: beliefs/feelings/attitudes toward health, relaxation/imagery techniques, nutrition, exercise, stress management, self-esteem, spirituality, receptive imagery/intuition, problem solving and personal health plan setting. The 21 breast cancer patients who received intervention were matched with 74 breast cancer patients of the same stage. There were two to three matched controls for each patient

At 4 to 7 years follow up none of the intervention group had died, 12% of the control group had died (median follow-up 4.2 years)

Participation in health psychology classes

The intervention control group lived significantly longer (p = 0.042)

Goodwin et al. 2001 [40]

Women participating in the intervention group attended weekly meetings lasting 90 minutes. Therapy intended to foster support among members and encourage the expression of emotions about cancer and its effects on their lives. Patients were encouraged to attend sessions for at least 1 year. The primary outcome was survival and the secondary psychosocial function assessed by self-report questionnaires (Profile of Mood States and Pain Suffering Scales by Spiegel-Bloom) at baseline and at 4, 8 and 12 months

By the time of analysis 201 patients had died. The median survival for the intervention group was 17.9 months, and for the control group was 17.6 months

Participation in supportive-expressive group therapy

There was no significant association between psychosocial intervention and breast cancer survival