Intervention program boosts survival in breast cancer patients

A new study provides the best evidence to date that a psychological intervention program designed for breast cancer patients not only improves their health - it actually increases their chance of survival.

Researchers at Ohio State University's Comprehensive Cancer Center found that patients participating in an intervention program reduced their risk of dying of breast cancer by 56 percent after an average of 11 years.

Participants in the program, which taught strategies to reduce stress, improve mood and alter health behaviors, also reduced the risk of breast cancer recurrence by 45 percent.

"The results suggest that we can help breast cancer patients make positive steps that may help them live longer and make recurrence less likely," said Barbara Andersen, lead author of the study and a member of Ohio State's Comprehensive Cancer Center and professor of psychology.

"We already knew a psychological intervention program could help breast cancer patients to handle their stress, function more effectively, and improve their health. Now we know it does even more."

The study will be published in the Dec. 15 issue of the journal Cancer, and is currently available to subscribers online.

The study is part of the long-running Stress and Immunity Breast Cancer Project at Ohio State. Participants included 227 patients who were surgically treated for Stage II or Stage III breast cancer.

Half of the patients were enrolled in the intervention program, while the other half were simply assessed on a regular basis. All received their regular medical treatments as well.

Those in the intervention group met weekly in groups of 8 to 12 with a clinical psychologist. During these weekly sessions, which continued for four months, participants learned progressive muscle relaxation for stress reduction, problem solving for common difficulties (such as fatigue), how to find support from family and friends, exercise and diet tips, and how to deal with treatment side effects and keep up with medical treatment and follow-up.

After four months of weekly sessions, participants met monthly for eight months.

Researchers have followed up regularly with all those who took part in the study. By October 2007, patients had been followed from 7 to 13 years.

In addition to improving survival and reducing recurrence, the intervention program had other positive effects, said Andersen.

Among patients who died of breast cancer, those who participated in the intervention program lived longer - an average of 6.1 years for program participants versus 4.8 years for those who were simply assessed.

Intervention participants were also less likely to die from causes other than breast cancer, such as heart disease or other cancers. For those who died of any cause, participants in the intervention lived an average of 6 years compared to 5 years for those who didn't.

"Many of the strategies patients learned in the intervention program, such as stress reduction, may have protected them from heart disease and other causes of death," Andersen said.

Researchers did a follow-up analysis in which they excluded people who were put in the intervention group, but who attended fewer that 20 percent of the sessions (16 of the 114 participants fit this requirement). When the infrequent attendees were excluded, the remainder had a 68-percent reduced risk of breast cancer death, compared to the 56-percent risk reduction for the whole participant group.

Andersen said this study was unique in several ways. In the 1980s and 90s, two separate studies found higher survival rates for cancer patients who participated in intervention programs; one study involved breast cancer patients whose disease had already recurred, and the other study included newly diagnosed melanoma patients. But these studies were not designed to look at how the interventions affected survival rates. When other researchers tried to replicate these results, they found no effect for intervention programs.

This new study, though, was designed to look specifically at recurrence and survival rates, Andersen said. In addition, the intervention program is different and so are the participants in the study.

Participants in the Ohio State study had Stage II and III breast cancer, which means their chance of survival were better than those with Stage IV cancer (which means the cancer has spread to other parts of the body), but not as good as those diagnosed with Stage I.

"We wanted those patients in the middle, where we felt we had the most chance of influencing their future course with the disease," she said.

How did the intervention program help cancer patients?

"We believe the significant psychological improvements and behavior changes may have been critical," according to Andersen.

For example, the researchers found that patients in the intervention group who had the greatest reductions in distress and physical symptoms were those who practiced progressive muscle relaxation most frequently. They also understood and remembered that continued stress could hurt their health and now knew several ways to reduce stress.

"We found a strong relationship between patients' use of the intervention strategies we taught them and better health," she said.

Previous research with the same women in this study showed that women in the intervention showed signs of improved immune function compared to those who did not participate. That is most likely related to the lower levels of distress they felt, Andersen said.

Overall, the results show a promising new way to help treat cancer patients, she said.

"If psychological interventions to reduce stress are delivered early, they can improve mental health, health, and possibly even their odds of survival."

Co-authors on the study were William Farrar, professor of surgery; William Carson III, professor of surgery and associate director for clinical research at the OSU Comprehensive Cancer Center; Hae-Chung Yang, research associate in psychology; Deanna Golden-Kreutz, clinical research manager in medicine; Lisa Thornton, post-doctoral fellow in psychology; Charles Emery, professor of psychology; Donn Young, a biostatistician and research scientist in the OSU Comprehensive Cancer Center.

The study was supported by the National Institute of Mental Health and the National Cancer Institute, with additional help from American Cancer Society; Longaberger Company-American Cancer Society Grant for Breast Cancer Research; U.S. Army Medical Research Institute; the OSU Comprehensive Cancer Center; and the Walther Cancer Institute.