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Conrad Notes
a timely medical meeting newsletter

D. Spiegel, MD, Stanford University School of Medicine, Stanford, Calif, described an intervention program started 20 years ago. Under therapist direction, groups meet once weekly to learn networking with other cancer patients, managing emotional expression, "detoxifying" dying, taking time to change life's priorities, fortifying the patient's family, dealing more openly with physicians, and practicing self-hypnosis for pain control. A previous publication of his (Lancet 1989;888-91) prompted Spiegel to undertake a replicate study on whether psychosocial treatment increases survival of patients with metastatic breast cancer.
Lancet Report Mean survival time increased by nearly 18 months in the intervention group compared with controls. Fifty of 86 patients participated up to one year in supportive group therapy plus self-hypnosis for pain relief. All patients, including 36 controls, received standard oncological therapy. The average survival time from study entry to death was 36.6 and 18.9 months for test and control groups, respectively (p<0.0001). A Kaplan-Meier survival plot showed divergence in survival starting at 20 months or 8 months after the intervention ended. According to Spiegel, further analysis of the data uncovered a 50% decrease in pain associated with self-hypnosis.
Current Study A second 10-year survival study is underway with 125 enrolled metastatic breast cancer patients. The control group receives educational material alone while the others also participate in group therapy (intervention). About one third of the patients had 24 months of follow-up. Another two years of data are needed for definitive statistical analyses.

The investigator's interest in stress hormones led to several ancillary evaluations at one-year follow-up. Preliminary data show higher levels of morning cortisol in affect-suppressed patients. Lower prolactin or decreased thyroid stimulating hormone levels are associated with improved survival time as are higher blood lymphocyte counts.

Implications of Social Support Groups The work of Spiegel and others challenge medicine to redefine good medical care. It is good medicine to include social support to lessen the enormous use of health services by patients with untreated psychological problems. In Spiegel's opinion, effective psychological and pharmacological therapies are now available to relieve the anxiety and depression of cancer patients.

For professional correspondence, please contact Dr. Spiegel at: ms.psl@forsythe.stanford.edu

Eugene A. Conrad

Presented at Third World Congress of Psycho-Oncology, 5 Oct 1996.
CONRAD NOTES, © October 1996 All Rights Reserved
Eugene A. Conrad, PhD, MPH / ISSN 1078 / posted 9-Dec-1996

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