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 It’s been replaced by the belief among breast cancer survivors that support services will improve a woman’s immune system, and thus make her less prone to recurrence.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.
