psychotherapy benefits–views change
psychotherapy benefits–views change This seems to rattle the bucket for hormonals- interesting? dilly
New study: Psychotherapy shows mixed survival effects
in metastatic cancer Story List
January 3, 2007
By Bruce Jancin
SAN ANTONIO (EGMN) - Intensive group psychotherapy
didn’t result in longer survival time overall in
patients with metastatic breast cancer in a new
randomized prospective trial, unlike in an
often-quoted earlier positive study, Dr. David Spiegel
reported at a breast cancer symposium sponsored by the
Cancer Therapy and Research Center.
Dr. Spiegel’s earlier landmark randomized study
(Lancet 1989;2:888-91) frequently is cited at holistic
medicine conferences as a positive, scientifically
rigorous testimonial to the healing power of the
mind/body connection. But his attempt to replicate
these earlier findings failed in a new study of 122
women with metastatic and 3 with locally recurrent
breast cancer randomized to weekly
supportive-expressive group therapy plus educational
materials for at least 1 year or a control arm
receiving educational materials only.
At 14 years follow-up, overall mortality was 86%.
Median survival in the group-therapy arm was 30.7
months, not significantly different from 33.3 months
in controls. But there was an intriguing differential
treatment response, based upon tumor hormone receptor
status, noted Dr. Spiegel of the department of
psychiatry at Stanford (Calif.) University.
Estrogen receptor–negative patients randomized to
group psychotherapy survived a median of 29.8 months,
while estrogen receptor–negative controls lived a
median of only 9.3 months. In contrast, median
survival was similar in estrogen receptor–positive
women in the group therapy and control arms.
Dr. Spiegel’s hypothesis is that the failure to
replicate his positive study from the 1980s in the
total sample is a consequence of the major advances in
adjuvant hormonal therapy since then.
Tamoxifen and, more recently, aromatase inhibitors
have brought significantly improved survival, but they
are effective in women with hormone receptor–positive
disease only. That’s most patients. Their resultant
survival gains have been so substantial that
psychotherapy no longer provides significant
incremental benefit on this score, although patients
do find it beneficial in terms of quality of life, he
noted.
In contrast, patients with estrogen receptor–negative
disease are impervious to these advances in medical
therapy, leaving room for group therapy to retain a
proportionately much larger survival impact, the
psychiatrist explained.
The trial was sponsored by the National Institute of
Mental Health and the National Cancer Institute.
Still have little belief in psychotherapy Dilly,
Not sure if we are agreeing with each other or not.
Most people,l quite rightly, get really angry every time it is suggested that a positive mental attitude and a desire to beat their desease will somehow help them live longer. Psycholtherapy might help people adjust to their uillness and maybe lift depression, but I’d rely on oncologists, radiologists, surgeons, pharmacists etc. to improve life expectancy. Hormone treatments have indeed done much to improve the life expectancy of ER+ women.
Dr Spegel’s hyothesis would be the one he started with - presumably something along the lines that the results of an earlier study could be replicated. He had an hypothesis and he failed to support it - that should have been the end of report. Comments regarding the results do not constitute an hypothesis. Social scientists use the word “hyothesis” in a very exact way.
Dr Spegel’s attempt to create new spurious statistics by breaking the sample up into those that were ER+ and ER- after getting the wrong answer, didn’t impress me. Of the 122 in the original sample, how many were Er- ?
If the number was, as I suspect, small, that subset would not be testable using a Probability test. If statics cannot pass a Probability test then it means it is just a random outcome (pure chance).
Holey
Holey haven’t taken your super scientific approach but suspect that whatever your attitude br ca goes its merry way regardless.
I also think that a positive approach helps ladies through the Slough of Despond - best wishes, dilly