Do Community Cancer Support Groups Reduce Physiologic Stress

Institution: Stanford University
Investigator(s): David Spiegel, M.D. - Mitch Golant, Ph.D. -
Award Cycle: 1998 (Cycle IV) Grant #: 4BB-2901 Award: $726,152
Award Type: CRC Full Research Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

This is a collaboration with: 4BB-2900 -

Initial Award Abstract (1998)
This study is designed to evaluate the strengths and weaknesses of two different community-based support group interventions for breast cancer patients. We plan to compare them with a model developed in the university setting, study which aspects are most effective, and who benefits the most. This proposal is based on a year-long collaborative effort with The Wellness and Cancer Support Communities, two major cancer support programs providing group interventions.

This proposal is responsive to the BCRP priority issue: Innovative Treatment Modalities. We plan to apply careful methods to understanding the effectiveness of two well-established support group programs in Northern California. This will allow us to refine and improve group interventions, and better match specific ones to those who will most benefit. We have devoted the past year to developing a close working relationship between these two community programs and the Psychosocial Treatment Laboratory in the Department of Psychiatry & Behavioral Sciences at Stanford University School of Medicine. We have already done research together which shows similarities and differences in these group programs. We have also built the mutual trust necessary to allow for such systematic study. All three programs have demonstrated a strong willingness to work closely with one another, and to learn from one another. This program emphasizes diversity and community-university collaboration in developing better group support services for breast cancer patients.

We will ask 96 women with recently diagnosed breast cancer at The CSC in San Francisco and The Wellness Community—East Bay in Walnut Creek to participate in the study. They will be randomly assigned (by a process like tossing a coin) at each site to their typical group program or Supportive/Expressive group therapy supervised by Stanford but administered there. We will ask participants to fill out questionnaires about their emotional distress, means of coping with cancer, social and family support, background, and evaluation of their group experience every four months for a year. Their physiological response to stress will also be measured using saliva samples. We will use this information to determine how well these groups work, and for whom they work best.

There is a growing body of evidence that participating in support groups improves the quality of life of breast cancer patients. The existence of community support programs provides a means of offering such effective support rapidly and inexpensively, making it available to diverse populations of breast cancer patients. The combination of this community-based effort and university research program provides the potential for improving all of these programs and providing evidence to support health policy changes. This could lead to programs of group support throughout the state of California, offering comfort, guidance, and support to all women coping with breast cancer.


Final Report (2002)
Women with primary breast cancer may benefit from participating in support groups as they cope with treatment and the psychological challenges of survivorship. Studies have documented that these women benefit from support groups run in a university setting; however, no one has documented benefit from community cancer support groups. There are many community cancer support groups that provide service to a large number of women with breast cancer. Therefore it is important to know if these groups are providing comparable service to well-researched support groups. We conducted this study as the first randomized study of community- compared to university-style support groups. Women had a 50/50 chance of being assigned to either a community or a university style support group.

This study evaluated the strengths and weaknesses of two community-based support group interventions for breast cancer patients [The Wellness (TWC) and Cancer Support (CSC) Communities, in the San Francisco area]. We compared them with a type of therapy developed in the university setting (Stanford's Supportive-Expressive group therapy), studied which aspects are most effective, and who benefited the most. We compared these women on several dimensions: change in emotional distress, means of coping with cancer, and social and family support. In addition, change in physiological response to stress was measured using saliva samples.

We were able to achieve recruitment for 6 of 8 groups originally proposed. We randomized 72 women in blocks of 12 taking consecutive women per site until we accrued 12 for each group. Of those, 61 women actually attended groups; of those, 46 women to date completed at least one follow-up and were available for analysis for this report. We screened 108 women, 16 who were screened out on initial phone contact, 20 women began to go through our baseline interviews and assessments and either decided not to enroll or dropped out before we could compose a group for the second S.F. randomization. Our final two follow-up assessments for our final group in the East Bay are currently (September 2002) being conducted (8 month) and will be conducted in October, 2002 (12 month) so they are not available for assay or analysis for this final report.

We examined 5 outcome variables for this report and found that women participating in the community groups changed at about the same level over the 4 months of group therapy as the women in the Stanford groups. This was true for depression symptoms, trauma symptoms, social support, self-efficacy, and post-traumatic-growth. These analyses are preliminary until we complete our final follow-up assessments.

It is encouraging for the community groups that women benefited at the same rate as they did in the well-researched Stanford groups. Conclusions for this study are somewhat limited because we could not complete the recruitment of our entire sample. However, there is every reason to suppose that community groups are as effective at serving women with primary breast cancer as Stanford's groups, even though they are based on very different ideas of therapy. It is important to note that all of these groups were led by therapists, and that we may have found other results if the groups had been led by peers or other types of professionals. This study has the potential to reduces the human and economic cost of breast cancer in California by validating community groups usually offered free to women with breast cancer.

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