Support Groups and Psychotherapy and the Affect on Breast Cancer

PJ Hamel Health Guide
  • Will joining a support group, or getting psychotherapy, help prolong your life as a breast cancer survivor?


    Yes, said Dr. David Spiegel, currently associate chair of psychiatry and behavioral sciences at Stanford, whose landmark 1989 study indicated that there was a “significant difference” in survival time between breast cancer patients who attended weekly support groups, and those who didn’t. Spiegel, a Yale and Harvard grad, published research revealing that support-group attendees lived an average of 36.6 months from the time they joined a support group, vs. the control group of women not seeking support services, who lived an average of 18.9 months. That study has been widely referred to ever since by women claiming the value of support services.

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    No, say numerous subsequent studies, including one by Dr. James Coyne, whose paper in the May issue of the Psychological Bulletin refutes Spiegel’s study. Coyne, a Carnegie-Mellon and IndianaUniversity grad, is currently an investigator at the Leonard and Marilyn Abramson Family Cancer Research Institute in Philadelphia. He’s also co-director of Health Services and Behavioral Sciences at the University of Pennsylvania, where he’s a professor. He’s consistently ranked among the top 20 psychologists in North America for impact of his work, as measured in citation analyses.


    But does that mean psychotherapy and support groups for breast cancer patients are a waste of time?


    Absolutely not, says Dr. Coyne. So long as the women receiving psychotherapy, or attending a support group, understand what they’re there for: what the benefits are and, just as importantly, what they aren’t. (And what’s the difference between psychotherapy and a support group, by the way? Dr. Coyne clarifies that psychotherapy is more leader-focused, with more specific tasks; while a support group is more woman-to-woman, involving women drawing on their own expertise.)


    “The sooner we get to the bottom of this, the better,” said Dr. Coyne in a recent interview, referring to the oft-disputed strength of the link between mind and body. While Eastern societies have long believed in a strong mind-body link, with the mind able to control many of the body’s physical functions, Western society has had a harder time embracing this link, preferring to look at the purely scientific picture. Now, however, as Eastern practices (Reiki, Tai Chi, yoga, meditation, et. al.) are slowly gaining more credence in the West–witness the popularity of Dr. Mehmet Oz and the success of his books–Coyne warns that there’s a certain danger attached to this shift. “Let’s not oversell the mind-body benefits, and give short shrift to the psychological benefits,” he said. “Quality of life is important, too; we don’t want that attitude of ‘You only feel better, but you’re really not better.’ ” 


    Dr. Coyne, when asked what had prompted him to undertake his study concerning survival rates and support groups, said that lots of literature has accumulated since Spiegel’s research, including recent studies that refute Spiegel’s findings. “I’d been thinking, how, as behavioral scientists, can we help [cancer survivors]?”  Coyne said he’s recently been studying male cancer survivors without partners, and how they seem to be at a disadvantage in the adherence to and outcome of cancer treatment, compared to women without partners. “Why is this, I wondered? What are the behaviors involved? I began thinking about survival–and that led me to re-examine the Spiegel study.” 

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    Coyne said that Spiegel’s study included a control group of just 36 women. And its original goal was not to examine the link between support groups and survival, but between support groups and quality of life. It was only 2 years after the fact, when there was a still-unexplained surge in the number of deaths in the control group, that the Spiegel study went back and concluded that not participating in a support group had, indeed, shortened the control group’s survival time. “Wally Sampson, a physician referring patients to Dr. Spiegel, was a harsh critic at the time,” noted Coyne. “He really doubted those results.”


    For a small study from 18 years ago, a study whose results have been in question almost from the start, the Spiegel data has had long legs. Up until recently, studies revealed that 25% of breast cancer survivors believed psychotherapy or a support group would help prolong their lives. Why is this? “Cancer patients have traditionally been pretty passive with their treatment,” Dr. Coyne noted. “Radiation, drugs, they just have to sit back and take it. But people like to be in control. It’s very hard for them to accept that there’s little they can do to influence the outcome of their treatment,” he said. “Support groups and psychotherapy–both ‘mind matters’– are satisfying,” because they give people a sense of control. However, added Coyne, “We don’t want to distract women from ‘real’ treatment, by giving them the false illusion that psychotherapy will cure them.” 


    More recently, said Coyne, this belief in the curative power of support groups has diminished. It’s been replaced by the belief among breast cancer survivors that support services will improve a woman’s immune system, and thus make her less prone to recurrence.


    What, then, is the true value of psychotherapy? Of a support group? Should most women routinely seek psychotherapy when dealt a diagnosis of breast cancer? Dr. Coyne, despite what one might think of as a natural bias towards treatment considering his profession, thinks not. “Many women have very good support systems already,” he said. “And some women just don’t do well in groups; they’re quiet, and don’t want to open up.” He added that support groups can actually be harmful, in some cases. “We’ve found that with advanced cancer patients, being in a support group can put them at risk for a whole new set of losses. Untimely deaths can devastate the group; a death can cause the whole group to deteriorate,” he concluded.


    In the end, it’s up to each woman to determine her need for psychotherapy, or for a support group. Studies show that support groups won’t help you to live longer; but that they will improve the quality of your life. And that’s huge. As Dr. Coyne concluded in our interview, “Let’s not sell short the benefit of feeling better.” Amen to that.

Published On: May 09, 2007