Abstract
An unexpected finding that a specific form of group therapy had a significant survival effect for women with metastatic breast cancer reported by Spiegel era/. (1) has generated considerable interest in the evaluation of related psychosocial interventions. The reported results of other group interventions have raised both enthusiasm and doubt about significant survival effects. Fawzy’s work (2, 3) has demonstrated a significant survival and quality-of-life effect as reflected in improved measures of coping as well as vigour, depression, confusion and fatigue. Other reports (4-61, in contrast, have failed to demonstrate a significant survival effect or quality-of-life impact. Further investigation, in particular attempts to replicate the Spiegel intervention, would help to resolve concerns regarding the efficacy of such interventions and might identify the factors that may mediate the therapy’s effects. This evaluation of psychosocial interventions should be undertaken with the same degree of applied rigour as any medical intervention study with attention to such factors as dosing and frequency of the interventon, structure and rationale of the intervention, social integration and group cohesion, acquisition of active coping skills, adherence to the intervention protocol and competent therapeutic leadership.
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