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Support Groups May Boost Quality of Life, Not Survival For more than a decade, conventional wisdom has held that participation in a support group can extend the lives of breast cancer patients. This belief was largely based on the results of a single study, published in 1989, which found that women with advanced breast cancer who participated in a support group lived about 18 months longer that those who did not.
Now the results of a new study challenge this conventional wisdom. The new research, published in the New England Journal of Medicine on December 13, 2001 (see the journal abstract), found that patients survived about the same length of time whether they took part in a support group or not. However, support group participation did improve patients' mood and perception of pain.
Between 1993 and 1998, Canadian researchers recruited 235 women with metastatic (advanced) breast cancer who were receiving treatment at cancer centers across Canada. Two-thirds of the women were randomly assigned to attend a therapist-led support group that met for 90 minutes once a week. The remaining women did not participate in a support group. Upon enrollment in the study and at intervals for the following year, the women completed questionnaires that asked about mood and pain.
Group leaders were trained in supportive-expressive group therapy, a standardized treatment that encourages participants to express feelings and concerns about their illness in a supportive environment. The same form of therapy was used in the 1989 study. The current study was led by Pamela Goodwin, M.D., of Mount Sinai Hospital at the University of Toronto.
Women who received group therapy survived for an average of 17.9 months, compared with 17.6 months for the control group that received no therapy -- an insignificant difference. However, women who received group therapy reported less worsening of pain and had significantly lower scores on measures of depression, anxiety and bewilderment. Women who were highly distressed when they entered the study benefited from group therapy more than women who were initially less distressed.
Do these findings mean support groups for cancer patients are a waste of time? Emphatically not, say two experts.
"This study adds to a body of evidence that support groups can improve cancer survivors' mood, pain, symptom control and social functioning," says Julia Rowland, Ph.D., director of the National Cancer Institute's Office of Cancer Survivorship. "It confirms that we can improve the quality of life for metastatic cancer patients."
Whether support group participation may extend survival for some patients remains an open question, says Donald Rosenstein, M.D., chief of the psychiatry consultation service at the National Institutes of Health Clinical Center.
"This is a well-done study but it is not conclusive," he says. "There is a lot we still don't know about the effects a cancer patient's mindset may have on their disease. Strong data support the beneficial effects of support groups on anxiety, depression and feelings of isolation. There is some data to suggest that some individuals' lives may be prolonged. There may be variables associated with longer survival that we have not yet identified."
Two things can be concluded from the new research, Rowland and Rosenstein agree.
Support groups help many breast cancer patients cope better with the symptoms, pain and stress of their disease, improving their quality of life. No breast cancer patient should feel guilty about not wanting to participate in a support group.
"A myth has been perpetuated that if I just go to a support group I'll feel better and live longer," says Rowland. "That's probably not the case. Support groups vary enormously. They can be very helpful for people who feel comfortable in a group, but they aren't the answer for everybody. These new findings take the pressure off survivors who may feel they have to join a support group."
The differing results of the new study and the 1989 study may be explained by changes in breast cancer treatment over the past two decades, says David Spiegel, M.D., of Stanford University Medical School, in an editorial accompanying the report of new study. Spiegel led the 1989 study that found a survival benefit from support group participation.
Both medical treatment of breast cancer and support services for patients have improved substantially since the late 1970s, when he and his colleagues began their study, Spiegel writes. These improvements in care may have made it difficult to replicate the effect of support group participation on survival time that the earlier study found.
Support services for breast cancer patients are much more comprehensive than those for patients with other tumors, says Rowland. It's possible, she suggests, that if the same form of group therapy used in the two breast cancer studies were offered to other cancer patients -- such as patients with lung or pancreatic cancer -- who have access to fewer resources for support, a beneficial effect on survival might well be observed.
Two breast cancer survivors who have participated in support groups think it misses the point to focus on whether or not taking part in such groups helps patients to live longer.
"People join support groups for the psychosocial and quality-of-life benefits," says Diana Rowden, 49, of Dallas, Texas, who was diagnosed with early-stage breast cancer in 1991. "It helps with pain and symptom management and it gives you coping skills, as well as tips on communicating with your doctor."
Six-year survivor Cindy Geoghegan, 41, of Wilton, Conn., thinks access to quality of care influences survival more than support group participation. "I never went to my support group thinking this is something I have to do or I'm not going to get better," she says. The value of support groups, she believes, lies in the opportunity they provide for patients to share experiences and coping strategies with people who understand what they are going through. "But not all support groups are equal, and some people are group joiners whereas others are not."
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