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A Randomized Clinical Intervention Trial

Catherine Classen, PhD; Lisa D. Butler, PhD; Cheryl Koopman, PhD; Elaine Miller, RN, MPH; Sue DiMiceli, BA; Janine Giese-Davis, PhD; Patricia Fobair, LCSW, MPH; Robert W. Carlson, MD; Helena C. Kraemer, PhD; David Spiegel, MD

Arch Gen Psychiatry. 2001;58:494-501.

Background  Metastatic breast cancer carries with it considerable psychosocial morbidity. Studies have shown that some patients with metastatic breast cancer experience clinically significant anxiety and depression and traumatic stress symptoms. Supportive-expressive group psychotherapy was developed to help patients with cancer face and adjust to their existential concerns, express and manage disease-related emotions, increase social support, enhance relationships with family and physicians, and improve symptom control.

Methods  Of 125 women with metastatic breast cancer recruited into the study, 64 were randomized to the intervention and 61 to the control condition. Intervention women were offered 1 year of weekly supportive-expressive group therapy and educational materials. Control women received educational materials only. Participants were assessed at baseline and every 4 months during the first year. Data at baseline and from at least 1 assessment were collected from 102 participants during this 12-month period, and these participants compose the study population.

Results  Primary analyses based on all available data indicated that participants in the treatment condition showed a significantly greater decline in traumatic stress symptoms on the Impact of Event Scale (effect size, 0.25) compared with the control condition, but there was no difference in Profile of Mood States total mood disturbance. However, when the final assessment occurring within a year of death was removed, a secondary analysis showed a significantly greater decline in total mood disturbance (effect size, 0.25) and traumatic stress symptoms (effect size, 0.33) for the treatment condition compared with the control condition.

Conclusion  Supportive-expressive therapy, with its emphasis on providing support and helping patients face and deal with their disease-related stress, can help reduce distress in patients with metastatic breast cancer.

From the Departments of Psychiatry and Behavioral Sciences (Drs Classen, Butler, Koopman, Giese-Davis, Kraemer, and Spiegel and Mss Miller and DiMiceli), Radiation Oncology (Ms Fobair), and Medicine/Oncology (Dr Carlson), Stanford University School of Medicine, Stanford, Calif.

Corresponding author and reprints: Catherine Classen, PhD, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94131-5718 (e-mail: classen{at}leland.stanford.edu).

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