Psychological Interventions Improve Survival

A new study to be published in the December 15th issue of Cancer, a peer-reviewed journal of the American Cancer Society, has already generated excitement. In a nutshell:

For 11 years, Dr. Barbara L. Andersen and colleagues at Ohio State University followed 227 breast cancer survivors from the time of diagnosis on. All the women were treated for regional cancer (i.e., not widespread metastatic cancer). Women were randomized to receive (1) routine medical care or (2) routine medical care plus "intervention" - namely, sessions with a professional who worked with them on improving mood, developing coping strategies and altering health behaviors. 

The results? Women who were randomized to the intervention group had about half the risk of cancer recurrence. Of those whose cancer recurred, they had about six months longer of being disease-free before the recurrence. Most impressively, the women who received the intervention had less than half the risk of dying of their cancer and a lower death rate from any cause. 

For many years, researchers have been looking at the role of psychological interventions in survivorship. A landmark study by Stanford psychiatrist Dr. David Spiegel in 1989 brought the issue into a limelight-of-controversy that has persisted to the present.

Nobody argues that skillful psychological interventions confer significant quality-of-life benefits, such as improved mood, better quality sleep and decreased pain. The big question is: Does such intervention lengthen lives in cancer survivors?

For the next few blog posts, let's talk about how the findings of this new study might affect Healthy Survivors. Your thoughts?

Comments

[Ronni Gordon]

The research is encouraging. I have always felt extremely well cared-for as a "whole person" at Dana-Farber. I love my social worker. She came in and talked me through many down times when I was in the hospital, and now I meet with her periodically at the clinic. A nurse practitioner who does reiki, breath work and yoga also saw me a lot, and I still see her from time to time at the clinic. The doctors were pretty busy, but in the hospital their PAs and also the nurses always had time to talk. Outpatient, if I mention a concern, they make sure I have the right person to discuss it with. (They discuss it with me too, but the doctor and nurse practitioner are so busy that they can't really sit down for a long period, although I don't usually feel that they are rushing out either.) This all leads to "good vibes," and I like to think that those vibes are helping me with my healing on physical as well as psychological levels.

[Wendy S. Harpham, MD]

Dear Ronni,

Despite great strides in understanding the molecular biology of illness and healing, much remains a mystery.

The emotional benefits to patients of psychosocial support are enough to justify investing in the programs and personnel to deliver such support to all patients who want or need it.

When studies report that psychosocial support might lengthen lives, a big benefit is strengthening the argument for insurers to cover such services better than they do now.

Many healthcare professionals, like Dr. Jimmie Holland, have been advocating for patients for a long time, trying to make psychosocial interventions the standard of care. Unfortunately, oftentimes insurers want to see proof in numbers.

With hope, Wendy

[Thomas A. Warr, MD]

Wendy - thanks for the link. That is a dramatic effect on survival. I imagine the patients recieving psychological support also had better quality of life. The study is exciting. I shared it with our staff and patients.

Don't forget that moderate exercise, keeping the weight down, eating less fat and more fresh fruits and vegetables are also effective in improving cancer specific survival.

Tom Warr
Great Falls

[Wendy S. Harpham, MD]

Yes, and your point about general health-promoting measures is well-taken. It's easy to get caught up looking for quick and easy solutions, like popping a pill, instead of pursuing a healthy diet, an appropriate exercise program, a restorative sleep pattern and healing support, all of which take more effort and time. Thanks for the reminder that these measures are important.

With hope, Wendy

[WhyMommy]

This is amazing to me. I'll never forget my (cancer center mandated) meeting with the psyc at the cancer center. I detailed my plans for beating this thing and keeping my spirits up, all very positive, and she said,

"That's nice, but there's no proof that a positive attitude helps you fight cancer."

What?

"There are no studies that show it, so if it helps you, great, but don't work too hard at it."

I didn't listen. And I'm here today.

[Wendy S. Harpham, MD]

Dear WhyMommy,
Your comment highlights the sticking point of the mind-body controversy: how the connection is presented to the patient can help or hurt. I'll address this more fully in a new post soon.

Your comment suggests you were motivated and calmed by the notion that attitude and actions make a huge difference. The problem arises when patients feel burdened and overwhelmed by the same notion. Or when they suffer a complication or recurrence, and they conclude it is all their fault.

Healthy Survivors find a balance that helps them get good care and live as fully as possible. As a Healthy Survivor, you rejected a statement that wasn't helping you live as a Healthy Survivor.

With hope, Wendy