Grant Number:	5R01MH047226-12 Interpret this number
Primary Investigator:	Spiegel, David
Organization:	Stanford University
Project Title:	Psychosocial Treatment Effects on Cancer Survival
Fiscal Year:	2001

NIMH is supporting a 10-year investigation by our laboratory of the influence of psychosocial treatment on survival of women with metastatic breast cancer. We have recruited 125 metastatic breast cancer patients, and randomly assigned them either to one year of weekly supportive/expressive group therapy or to an educational control condition. This research is designed to replicate and extend our earlier finding that metastatic breast cancer patients randomly assigned to a year of weekly supportive/expressive therapy (SET) groups lived an average of 18 months longer than control patients (Spiegel et al., 1989). In this competing continuation we seek to accomplish two overall Aims: In Aim 1 we seek to complete follow-up of long-term survivors in our existing study. We currently have 73% overall mortality and must follow the sample until treatment/control differences in survival are analyzable at greater than 90% mortality. We have discovered an abnormality in diurnal variation of cortisol that predicts significantly shorter survival time, and plan to pursue our investigation of HPA dysfunction and breast cancer progression. In addition, we will examine the characteristics that distinguish long-term survivors, and mediators of treatment effects, specifically, analyses of in-group emotional expression and diurnal cortisol. In Aim 2 we seek to recruit a new, socioeconomically and ethnically diverse sample of 180 metastatic breast cancer patients with a range of PTSD. The sample will include 60 patients who meet diagnostic criteria for cancer-related posttraumatic stress disorder (PTSD), 60 patients with partial cancer-related PTSD, and 60 patients without a cancer-related PTSD diagnosis, as a comparison group. The subaims of this new study are to: A) evaluate the efficacy of SET on PTSD and other psychiatric Symptoms, quality of life, and survival in metastatic breast cancer patients with PTSD; B) examine hypothesized mediators of treatments effects (including emotional expression and cognitive processing of cancer-related stressors); and C) identify correlates of baseline adjustment (including SES, trauma/PTSD history, social constraints) and moderators of treatment response (including level of PTSD symptoms). The results of this study will provide evidence of the efficacy of group psychotherapy for metastatic breast cancer patients, including those with comorbid psychiatric (PTSD) symptoms, on the basis of proven psychiatric, psychosocial, and health benefits. The recruitment of this diverse sample of patients will also increase generalizability of findings regarding group psychotherapy outcome and its predictors.




Deconstructing therapeutic mechanisms in cancer support groups: do we express more emotion when we tell stories or talk directly to each other?
Authors: Tamagawa R. , Li Y. , Gravity T. , Piemme K.A. , DiMiceli S. , Collie K. , Giese-Davis J. .
Source: Journal Of Behavioral Medicine, 2015 Feb; 38(1), p. 171-82.
PMID: 25096409
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Mind matters in cancer survival.
Authors: Spiegel D. .
Source: Jama, 2011-02-02 00:00:00.0; 305(5), p. 502-3.
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Authors: Palesh O.G. , Collie K. , Batiuchok D. , Tilston J. , Koopman C. , Perlis M.L. , Butler L.D. , Carlson R. , Spiegel D. .
Source: Biological Psychology, 2007 Apr; 75(1), p. 37-44.
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Emotional expression and diurnal cortisol slope in women with metastatic breast cancer in supportive-expressive group therapy: a preliminary study.
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Source: Biological Psychology, 2006 Aug; 73(2), p. 190-8.
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Improving methods of assessing natural killer cell cytotoxicity.
Authors: Sephton S.E. , Kraemer H.C. , Neri E. , Stites D.P. , Weissbecker I. , Spiegel D. .
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Anticipating loss and other temporal stressors predict traumatic stress symptoms among partners of metastatic/recurrent breast cancer patients.
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Source: Psycho-oncology, 2005 Jun; 14(6), p. 492-502.
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The interaction of social network size and stressful life events predict delayed-type hypersensitivity among women with metastatic breast cancer.
Authors: Turner-Cobb J.M. , Koopman C. , Rabinowitz J.D. , Terr A.I. , Sephton S.E. , Spiegel D. .
Source: International Journal Of Psychophysiology : Official Journal Of The International Organization Of Psychophysiology, 2004 Nov; 54(3), p. 241-9.
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Repression and high anxiety are associated with aberrant diurnal cortisol rhythms in women with metastatic breast cancer.
Authors: Giese-Davis J. , Sephton S.E. , Abercrombie H.C. , Durán R.E. , Spiegel D. .
Source: Health Psychology : Official Journal Of The Division Of Health Psychology, American Psychological Association, 2004 Nov; 23(6), p. 645-50.
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Cytotoxic T lymphocyte count and survival time in women with metastatic breast cancer.
Authors: Blake-Mortimer J.S. , Sephton S.E. , Carlson R.W. , Stites D. , Spiegel D. .
Source: The Breast Journal, 2004 May-Jun; 10(3), p. 195-9.
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Psychological distress and pain significantly increase before death in metastatic breast cancer patients.
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Sleep disturbances in women with metastatic breast cancer.
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Source: The Breast Journal, 2002 Nov-Dec; 8(6), p. 362-70.
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Change in emotion-regulation strategy for women with metastatic breast cancer following supportive-expressive group therapy.
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Source: Journal Of Consulting And Clinical Psychology, 2002 Aug; 70(4), p. 916-25.
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Spiritual expression and immune status in women with metastatic breast cancer: an exploratory study.
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Source: The Breast Journal, 2001 Sep-Oct; 7(5), p. 345-53.
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Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial.
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Source: Archives Of General Psychiatry, 2001 May; 58(5), p. 494-501.
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Social support and salivary cortisol in women with metastatic breast cancer.
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Traumatic stress, life events, and emotional support in women with metastatic breast cancer: cancer-related traumatic stress symptoms associated with past and current stressors.
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Social support, life stress, pain and emotional adjustment to advanced breast cancer.
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Coping styles associated with psychological adjustment to advanced breast cancer.
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Pain and depression in patients with cancer.
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