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In Reply:

Memorial Sloan-Kettering Cancer Center, New York, NY

Cunningham and Edwards make valid points about specific subgroups of patients that may be helped. More targeted interventions to patients with particular needs are desirable.

Solid research data exist stating that depressed patients have lower rates of survival,¹ but mechanisms are not yet elucidated. An attractive hypothesis is nonadherence to effective anticancer treatments by patients who have "given up," become demoralized, or use primitive denial as their coping response. In addition to standard treatment with antidepressant medication, we have found evidence that group therapy has the ability to not only treat DSM-IV depressive disorders in women with advanced breast cancer, but also prevent the onset of new cases (submitted, Grabsch et al, 2005). We are challenged clinically to find reliable methods of recognizing these depressed and otherwise "at risk" patients with screening methods showing considerable promise.²

More research is called for to explore interventions that promote adherence to cancer treatments such as chemotherapy. Such targeted approaches will enhance quality of life while aligning psycho-oncologists in a useful partnership of complementary care with oncologists.

The absence of a substantial survival benefit emerging from the more recent trials of group therapy may give peace of mind to patients less comfortable in the group setting, who may have felt pressure to incorporate such a modality of treatment in their care plan. On the other hand, Pam Goodwin is a great advocate for the many psychosocial and quality-of-life benefits that can be achieved from these group interventions.

Author's Disclosures of Potential Conflicts of Interest

The author indicated no potential conflicts of interest.

REFERENCES

1. Watson M, Haviland JS, Greer S, et al: Influence of psychological response on survival in breast cancer: A population-based cohort study. Lancet 354:1331-1336, 1999[CrossRef][Medline]

2. McLachlan SA, Allenby A, Matthew J, et al: Randomized trial of coordinated psychosocial interventions based on patient self-assessments versus standard care to improve the psychosocial functioning of patients with cancer. J Clin Oncol 19:4117-4125, 2001[Abstract/Free Full Text]

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Related Correspondence

• Possible Effects of Psychological Therapy on Survival Duration in Cancer Patients
  Alastair J. Cunningham and Claire V.I. Edmonds
  JCO 2005 23: 5263 [Full Text]

This Article Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kissane, D. W. Search for Related Content PubMed Articles by Kissane, D. W. Related Articles Related Correspondence Social Bookmarking                            What's this?