Dr. Barbara L. Andersen and colleagues at the Ohio State University followed 227 breast cancer patients for an average of 11 years. At the start of the study, all had undergone breast surgery, but the cancer had not spread. All patients received their usual medical treatment, but half were also randomly assigned to psychological intervention groups. Led by a psychologist, the 26 sessions were held over the course of a year and included relaxation techniques, advice on how to avoid becoming too tired and how to approach family and friends for support. The sessions also included some diet and exercise advice and information on how to cope with the side effects of cancer treatment.
Overall, by the end of the follow-up period, cancer had recurred in 62 of the 212 women for whom data was available and 54 of the total group had died. Patients receiving counseling had about half, 55 percent, the risk of recurrence compared with the control group. Those who did suffer a recurrence had been cancer-free for an average of six months longer than the patients in the control group, a 45 percent risk reduction. And among the 54 women who died, those who took part in the counseling sessions lived longer than the others. The study also found patients receiving counseling had less than half the risk, 44 percent, of death from breast cancer compared to those who did not receive the intervention, as well as a reduced risk of death from all causes, not just cancer. “Many of the strategies patients learned in the intervention program, such as stress reduction, may have protected them from heart disease and other causes of death,” Dr. Andersen said.
In a follow-up analysis, the researchers excluded people who were put in the intervention group, but who attended fewer that 20 percent of the sessions (16 of 114 participants fit this requirement). When the infrequent attendees were excluded, the remainder had a 68 percent reduced risk of breast cancer death, compared to the 55 percent risk reduction for the whole participant group.
Cancer patients undergo a great deal of stress before, during and after treatment. The researchers theorize that psychological interventions may affect immune system changes that are secondary to stress hormones and that may promote cancer growth or metastasis. They recommend that, in addition to powerful antitumor medications, cancer patients should be treated for psychological distress as well. “If efficacious psychological interventions to reduce stress are delivered early, they will improve mental health, health and treatment-relevant behaviors, and potentially, biologic outcomes,” the authors wrote. “If so there is the possibility for improved survivorship and survival for cancer patients.”
However, other experts are wary. Dr. Michael Stefanek, of the American Cancer Society, said other studies had come to the opposite conclusion. “Psychological interventions have been found in the majority of well-controlled studies to enhance quality of life and reduce distress. It would not be reasonable for patients to participate in psychological interventions with the goal of extending survival,” he said in a statement. “We should not conclude that psychological interventions increase survival among women with early stage breast cancer,” he added.
There are many approaches to outpatient psychological counseling and various ways for it to take place, including individual, group or family sessions. But regardless of where it takes place, sessions that concentrate on mood improvement, effective coping and health behavioral changes appear to reduce stress and help breast cancer patients live longer. “The results suggest that we can help breast cancer patients make positive steps that may help them live longer and make recurrence less likely,” Dr. Andersen said in a prepared statement. “We already knew a psychological intervention program could help breast cancer patients to handle their stress, function more effectively, and improve their health. Now we know it does even more.”
The study will be published in the December 15 issue of the journal Cancer, and is currently available to subscribers online.