Group Therapy and Cancer Survival-- Where Does the Evidence Lie in 2007?
By Tiffany Floyd, PhD, Barbara Lubrano di Ciccone, MD, and David W. Kissane, MD |
June 1, 2007
Dr Floyd is a research fellow, Dr Lubrano di Ciccone is a psychiatrist, and Dr Kissane is chair, department of psychiatry and behavioral sciences at Memorial Sloan-Kettering Cancer Center in New York. They report no conflicts of interest concerning the subject matter of this article.
Might specific subgroups of women be more likely to benefit from SEGT, such as women with specific personality characteristics or interpersonal styles?1 To date, there have been no studies of SEGT that have attempted to identify how personality and attachment styles might interact with group treatment in order to predict outcomes.
Another notable gap in the current literature has been the lack of representation of women from racial and ethnic minority backgrounds. This is particularly unfortunate given the well-documented disparity in breast cancer death rates between whites and racial and ethnic minorities, such as African Americans, and the differential rates of decline in breast cancer mortality (2.4% per year in whites, 1.8% in Latino women, and 1.0% in African Americans).23,24 The shortage of minority women might result from a lack of concerted effort or ingenuity during recruitment or the unwillingness of women to participate because of skepticism or fatalism. While the reason is most likely multifactorial, an effort should be made to address the issues that have prevented inclusion of more minority women.
In a cross-sectional study conducted by Bickell and colleagues,25 despite similar rates of oncological consultation, minority women with early-stage breast cancer had double the risk of white women of not receiving adjuvant treatment. Given that SEGT did enhance adherence to chemotherapy and hormone therapy in the Melbourne trial,17 could the intervention be adapted to respond sensitively to culturally based beliefs about illness and health, the doctor-patient relationship, and treatment preferences? Might the induction of some shift in these beliefs lead to improved adherence? Our research group is currently exploring this possibility. Measures of health beliefs are included in assessing the outcome of SEGT and serve as more proximal indicators of adherence to anticancer treatments. More research is needed to test this hypothesis and to elucidate the mediators of this effect.
The issues that women with advanced breast cancer face on a daily basis are taxing on both a physical and emotional level. SEGT can provide these women with the support needed to successfully adjust to the diagnosis and to find comfort in facing the illness head on. Although it remains to be determined whether SEGT can indeed improve treatment adherence and outcome for underserved populations, strong evidence supports SEGT as an effective intervention in reducing traumatic stress symptoms and, in most cases, improving mood symptoms. Future research is still needed, however, to address the points raised herein, including the personality and attachment styles that may respond well and the impact of culturally determined health beliefs on minority women.
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