Abstract
A pilot study was conducted to test the efficacy of a therapeutic group by telephone conference call for women with breast cancer. Sixty-six women with stage I or stage II breast cancer consented to participate in the study. Participants were randomly assigned to a usual psychosocial care or intervention group, using a permuted block method. Only 2 of 68 patients dropped out of the study, which included 27% African Americans. Assessments at 3 time periods (pretest, immediately after the intervention, and 3 months after the group ended) included evaluation of quality of life (QOL), mood, and immune function. t tests were performed to determine if differences on important variables existed at pretest. The intervention group had worse QOL and mood scores than did the control group on the pretests. A mixed-model repeated-measures procedure controlling for pretest differences was used to analyze data. A significant Group by Time interaction was found for spiritual well-being and mood. These differences were not in the expected direction. The intervention group showed improvement in QOL and mood during the intervention, but showed decompensation following the intervention. Conversely, the control group demonstrated stable or declining scores. This intervention is feasible and practical for women with breast cancer, especially African American participants. The puzzling results suggest several areas for future research, including a better conceptual fit with outcome measures, increasing dosage, and exploration of the value of emotional expression.
Despite advances in supportive care, women still experience severe stress from the diagnosis and treatment of breast cancer, resulting in poor quality of life (QOL) and negative mood. 1,2 Twenty to 30% of breast cancer patients experience long-term deleterious effects on QOL and mood. 3 Mood scores were so low in 25% to 35% of women having a mastectomy that they required referral for psychiatric evaluation. 4 Research indicates that participation in a therapeutic group (TG) counteracts the psychological effects of the disease and its treatment and may improve immune function. 5 Findings from more than 30 studies document the positive impact of TGs on QOL and mood. 6,7 Additionally, research indicates that a TG intervention is a more powerful approach than is individual therapy. 8,9
The link between the stress of cancer and immune function is not well understood. However, research suggests that cancer- related stress might decrease immune function, which in turn may influence disease progression and survival. 10,11 Two studies of TGs found that as QOL improved, both the number and the activity of natural killer cells increased. 12,13 In contrast, Richardson and colleagues 14 and van der Pompe et al 15 did not demonstrate changes in immune function following a TG intervention. Therefore, additional research on the effects of TG on immune function is needed.