Originally published as JCO Early Release 10.1200/JCO.2004.12.129 on September 27 2004

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Effect of Cognitive-Existential Group Therapy on Survival in Early-Stage Breast Cancer

From the Memorial Sloan-Kettering Cancer Center, New York, NY; Departments of Medicine and Psychiatry, St Vincent's Hospital; The Peter MacCallum Cancer Institute; The University of Melbourne; and School of Psychology, La Trobe University, Melbourne; and Department of Psychological Medicine and Medical Oncology, Monash Medical Center and Monash University, Victoria, Australia

Address reprint requests to David W. Kissane, MD, Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1242 Second Ave, New York, NY 10021; e-mail: kissaned{at}mskcc.org

PURPOSE: Cognitive-existential group therapy (CEGT) was developed to improve mood and mental attitude toward cancer in women with early-stage breast cancer receiving adjuvant chemotherapy. Given the debate about group therapy's association with increased survival in women with metastatic breast cancer, we were curious to check its effect at a much earlier stage in the cancer journey.

PATIENTS AND METHODS: We randomly assigned 303 women with early-stage breast cancer who were receiving adjuvant chemotherapy to either 20 sessions of weekly group therapy plus three relaxation classes (n = 154) or to a control condition of three relaxation classes alone (n = 149). The primary outcome was survival.

RESULTS: CEGT did not extend survival; the median survival time was 81.9 months (95% CI, 64.8 to 99.0 months) in the group-therapy women and 85.5 months (95% CI, 67.5 to 103.6 months) in the control arm. The hazard ratio for death was 1.35 (95% CI, 0.76 to 2.39; P = .31). In contrast, histology and axillary lymph node status were significant predictors of survival. Low-grade histology yielded a hazard ratio of 0.342 (95% CI, 0.17 to 0.69), and axillary lymph node–negative status yielded a hazard ratio of 0.397 (95% CI, 0.20 to 0.78).

CONCLUSION: CEGT does not prolong survival in women with early-stage breast cancer.

Supported by the Research and Development Grants Advisory Committee of the Australian Commonwealth Department of Health and Human Services, the National Health and Medical Research Council of Australia, and the Pratt Foundation.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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