转移性乳腺癌女性的支持性-表达性团体治疗：一项随机对照试验的生存及心理社会结果

Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial.

作者信息

Kissane David W, Grabsch Brenda, Clarke David M, Smith Graeme C, Love Anthony W, Bloch Sidney, Snyder Raymond D, Li Yuelin

机构信息

Department of Psychiatry and Behavioural Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.

出版信息

Psychooncology. 2007 Apr;16(4):277-86. doi: 10.1002/pon.1185.

DOI:10.1002/pon.1185

PMID:17385190

Abstract

BACKGROUND

Mixed reports exist about the impact of supportive-expressive group therapy (SEGT) on survival.

METHODS

From 485 women with advanced breast cancer recruited between 1996-2002, 227 (47%) consented and were randomized within an average 10 months of cancer recurrence in a 2:1 ratio to intervention with 1 year or more of weekly SEGT plus three classes of relaxation therapy (147 women) or to control receiving three classes of relaxation therapy (80 women). The primary outcome was survival; psychosocial well-being was appraised secondarily. Analysis was by intention-to-treat.

RESULTS

SEGT did not prolong survival (median survival 24.0 months in SEGT and 18.3 in controls; univariate hazard ratio for death 0.92 [95% CI, 0.69-1.26]; multivariate hazard ratio, 1.06 [95% CI, 0.74-1.51]). Significant predictors of survival were treatment with chemotherapy and hormone therapy (p<0.001), visceral metastases (p<0.001) and advanced disease at first diagnosis (p<0.05). SEGT ameliorated and prevented new DSM-IV depressive disorders (p = 0.002), reduced hopeless-helplessness (p = 0.004), trauma symptoms (p = 0.04) and improved social functioning (p = 0.03).

CONCLUSIONS

SEGT did not prolong survival. It improved quality of life, including treatment of and protection against depression.

摘要

背景

关于支持性表达性团体治疗（SEGT）对生存率的影响，存在不同的报道。

方法

在1996年至2002年招募的485例晚期乳腺癌女性患者中，227例（47%）同意参与研究，并在癌症复发后平均10个月内按2:1的比例随机分组，一组接受为期1年或更长时间的每周一次SEGT加三类放松治疗（147例女性），另一组接受三类放松治疗作为对照（80例女性）。主要结局是生存率；次要评估心理社会幸福感。分析采用意向性分析。

结果

SEGT并未延长生存期（SEGT组中位生存期为24.0个月，对照组为18.3个月；单因素死亡风险比为0.92[95%CI，0.69 - 1.26]；多因素风险比为1.06[95%CI，0.74 - 1.51]）。生存率的显著预测因素为化疗和激素治疗（p<0.001）、内脏转移（p<0.001）以及首次诊断时的晚期疾病（p<0.05）。SEGT改善并预防了新的DSM-IV抑郁障碍（p = 0.002），降低了无望无助感（p = 0.004）、创伤症状（p = 0.04），并改善了社会功能（p = 0.03）。