Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial

Abstract

Background: The question of whether stress poses a risk for cancer progression has been difficult to answer. A randomized clinical trial tested the hypothesis that cancer patients coping with their recent diagnosis but receiving a psychologic intervention would have improved survival compared with patients who were only assessed.

Methods: A total of 227 patients who were surgically treated for regional breast cancer participated. Before beginning adjuvant cancer therapies, patients were assessed with psychologic and behavioral measures and had a health evaluation, and a 60-mL blood sample was drawn. Patients were randomized to Psychologic Intervention plus assessment or Assessment only study arms. The intervention was psychologist led; conducted in small groups; and included strategies to reduce stress, improve mood, alter health behaviors, and maintain adherence to cancer treatment and care. Earlier articles demonstrated that, compared with the Assessment arm, the Intervention arm improved across all of the latter secondary outcomes. Immunity was also enhanced.

Results: After a median of 11 years of follow-up, disease recurrence was reported to occur in 62 of 212 (29%) women and death was reported for 54 of 227 (24%) women. Using Cox proportional hazards analysis, multivariate comparison of survival was conducted. As predicted, patients in the Intervention arm were found to have a reduced risk of breast cancer recurrence (hazards ratio [HR] of 0.55; P = .034) and death from breast cancer (HR of 0.44; P = .016) compared with patients in the Assessment only arm. Follow-up analyses also demonstrated that Intervention patients had a reduced risk of death from all causes (HR of 0.51; P = .028).

Conclusions: Psychologic interventions as delivered and studied here can improve survival.

FIGURE 1

The biobehavioral model of cancer stress and disease course is shown, noting psychologic (stress and quality of life), behavioral (compliance and health behaviors), and biologic pathways to disease progression. CNS indicates central nervous system. Copyright © 1994 by the American Psychological Association (APA). Reproduced with permission from Andersen BL, Kiecolt-Glaser JK, Glaser R. A biobehavioral model of cancer stress and disease course. Am Psychol. 1994;49:389-404. The use of APA information does not suggest endorsement by APA.

FIGURE 2

Disease-free, disease recurrence, death, and lost to follow-up status after a median of 11 years of follow-up are shown for 227 breast cancer patients randomized to the Intervention and assessment or Assessment only study arms.

FIGURE 3

Predicted cumulative survival of 227 breast cancer patients is shown according to study arm, Intervention and assessment arm versus Assessment–only arm. (a) Cumulative survival without breast cancer recurrence. (b) Cumulative survival without breast cancer-specific death. (c) Cumulative survival from all-cause death.