Separating the apples and oranges in the fruit cocktail: the mixed results of psychosocial interventions on cancer survival

Effects on long-term survival of psychosocial group intervention in early-stage breast cancer: follow-up of a randomized controlled trial

BACKGROUND

The promise of prolonged survival after psychosocial interventions has long been studied, but not convincingly demonstrated. This study aims to investigate whether a psychosocial group intervention improved long-term survival in women with early-stage breast cancer and investigate differences in baseline characteristics and survival between study participants and non-participants.

METHODS

A total of 201 patients were randomized to two six-hour psychoeducation sessions and eight weekly sessions of group psychotherapy or care as usual. Additionally, 151 eligible patients declined to participate. Eligible patients were diagnosed and treated at Herlev Hospital, Denmark, and followed for vital status up to 18 years after their primary surgical treatment. Cox's proportional hazard regressions were used to estimate hazard ratios (HRs) for survival.

RESULTS

The intervention did not significantly improve survival in the intervention group compared with the control group (HR, 0.68; 95% confidence interval (CI), 0.41-1.14). Participants and non-participants differed significantly in age, cancer stage, adjuvant chemotherapy, and crude survival. When adjusted, no significant survival difference between participants and non-participants remained (HR, 0.77; 95% CI, 0.53-1.11).

CONCLUSIONS

We could not show improved long-term survival after the psychosocial intervention. Participants survived longer than nonparticipants, but clinical and demographic characteristics, rather than study participation, seem accountable for this difference.

What is a psychological intervention? A metareview and practical proposal

OBJECTIVE

What do we mean by a 'psychological intervention' in the context of cancer care? It is critical to know what treatments are included under this term, if data from diverse treatment trials are to be summarized in order to inform clinical practice. We, therefore, aimed to determine how the term 'psychological intervention' has been defined and used to group and compare interventions in reviews of cancer care.

METHODS

We conducted a review of existing reviews (a metareview). These included systematic and narrative reviews and meta-analyses of interventions that were described as 'psychological', with the aim of determining: (a) the definitions for 'psychological interventions' that were used and (b) the treatments that were included within this category.

RESULTS

We identified 66 relevant reviews. Surprisingly, we were unable to find any explicit definition of the term 'psychological intervention' in these reviews. The reviews included 79 different treatments with little consistency between reviews in which treatments were included.

CONCLUSIONS

There is confusion about what 'psychological intervention' means in the cancer review literature. A clearer definition is essential to summarize research findings. We propose that rather than simply grouping interventions as 'psychological', it would be more useful if reviews focussed on specified domains of the interventions, namely content, proposed mechanism, target outcome, and methods of delivery. This would enable greater specificity in the review question, more meaningful comparisons, and would hopefully provide clearer answers for the readers of the reviews. A checklist for the summarizing of reports of interventions for review is provided.

Cancer nutrition rehabilitation program: the role of social work

The Cancer Nutrition Rehabilitation (cnr) program at the McGill University Health Centre is an interdisciplinary 8-week treatment program offering patients information, education, treatment, and support in areas such as diet, exercise, and rehabilitation, plus resources to address their psychosocial needs. The program social worker helps the patient and the patient's family to cope with the illness, to problem-solve, and to obtain needed resources. Here, we present a description of these patients-demographics, medical diagnoses, and psychosocial needs as assessed by the Person-in-Environment standardized instrument-derived from the social-work files of the 75 patients referred to social work in the period February 2007-December 2008. The reason most frequently reported for referral to social work was assistance with psychosocial problems. For 41.3% of the sample, these problems were assessed as high severity, and almost half the patients in the sample (47.8%) were assessed as having inadequate coping ability. Patient age was the most important demographic variable. Although seniors (63-94 years of age) were the least likely to have high-severity psychosocial problems, they were the most likely to have inadequate coping ability. That finding suggests that the cnr social worker, in addition to dealing with the instrumental, practical needs of cancer patients, is in a unique position to respond to their emotional difficulties in coping with their illness, and that health care professionals need to pay particular attention to the coping ability of elderly patients.