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|Clinicians Digest May/June 2008 - Page 3|
Physicians and therapists have recommended psychosocial support groups for thousands of cancer patients ever since Stanford University psychiatrist David Spiegel's landmark 1989 study found that women with breast cancer who attended a support group had a significantly greater survival rate. Meanwhile, below the media radar, critiques of his study and subsequent research have steadily chipped away at his finding.
Now a systematic review of 15 years of cancer-support-group studies in last May's Psychological Bulletin presents the strongest rebuttal yet to Spiegel. The analysis by psychologist James Coyne of the Abramson Cancer Center of the University of Pennsylvania finds that the few studies supporting Spiegel's findings share the methodological flaws that his had, and that studies with the best methodology show no difference in survival rates.
Coyne's review notes that the support groups studied by Spiegel and others who shared his findings were often more closely medically monitored than the control groups, calling into question how much of the survival difference actually came from the emotional support of the group and not from more intensive medical attention. In addition, Spiegel and others used the statistical mean to compare the survival times of patients in the support group to those not in the support group, but because survival rates are widely skewed, medical epidemiologists typically use the median, not the mean, for analysis. When Spiegel's results are recalculated using the median, the difference in survival shrinks from 36.6 months to 2 months.
Spiegel has acknowledged his own study's shortcomings concerning survival rates, but he and other health psychology researchers counter that cancer support groups improve quality of life, and that people who feel more optimistic, supported, and empowered are more apt to do things that affect survival—like take meds, exercise, and eat better. But even those assertions don't square with most research. Other studies have found that some cancer patients already suffering from significant emotional distress end up feeling more distressed in support groups. "Particularly with advanced cancer," says Coyne, "it can be devastating when you show up for a meeting and find out some group member has died whom you've invested in and from whom you've gotten a sense of well-being."