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Effects of an Early Structured Psychiatric Intervention, Coping, and Affective State on Recurrence and Survival 6 Years Later

Fawzy I. Fawzy, MD; Nancy W. Fawzy, RN, DNSc; Christine S. Hyun, MPH; Robert Elashoff, PhD; Donald Guthrie, PhD; John L. Fahey, MD; Donald L. Morton, MD

Arch Gen Psychiatry. 1993;50(9):681-689.

Abstract
Objectives
We evaluated recurrence and survival for 68 patients with malignant melanoma who participated in a 6-week structured psychiatric group intervention 5 to 6 years earlier, shortly after their diagnosis and initial surgical treatment. We also explored the role of several factors as possible predictors of outcome.

Design
This was a randomized controlled experimental study. The Cox proportion hazards regression model was used to quantify the relationship between treatment and the outcomes adjusted by the covariates (age, sex, Breslow depth, tumor site, baseline Profile of Mood States Total Mood Disturbance, baseline active-behavioral coping, baseline natural killer cell activity, and treatment [ie, group intervention]). The stepwise procedure was used for covariate selection.

Results
For control patients, there was a trend for recurrence (13/34) and a statistically significant greater rate of death (10/34) than for experimental patients (7/34 and 3/34, respectively). We found that being male and having a greater Breslow depth predicted greater recurrence and poorer survival. Analysis of multiple covariates found that only Breslow depth and treatment (ie, group intervention) were significant. Adjusting for Breslow depth, treatment effect remained significant. Finally, baseline affective distress and baseline coping were significant psychobehavioral predictors for recurrence and survival. Surprisingly, higher levels of baseline distress as well as baseline coping and enhancement of active-behavioral coping over time were predictive of lower rates of recurrence and death.

Conclusion
Psychiatric interventions that enhance effective coping and reduce affective distress appear to have beneficial effects on survival but are not proposed as an alternative or independent treatment for cancer or any other illness or disease. However, the exact nature of this relationship warrants further investigation.

Author Affiliations
From the Department of Psychiatry, UCLA School of Medicine (Drs F. Fawzy, N. Fawzy, and Guthrie and Ms Hyun); the Jonsson Comprehensive Cancer Center, UCLA (Drs Fawzy, Elashoff, and Fahey); the John Wayne Cancer Institute, Saint John's Hospital and Health Center (Drs N. Fawzy and Morton); the Departments of Biomathematics and Biostatistics (Drs Elashoff and Guthrie) and Microbiology and Immunology, UCLA School of Medicine (Dr Fahey); and the Center for Interdisciplinary Studies in Immunology and Disease (CIRID), UCLA School of Medicine (Dr Fahey), Los Angeles, Calif.

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