"Psychoeducation" doesn't increase melanoma survival
By David Douglas
NEW YORK (Reuters Health) - Contrary to earlier findings, a psychoeducational intervention provides no survival benefit and doesn't increase the time between treatment and recurrence in patients with malignant melanoma of the skin, Danish researchers report.
"However," lead investigator Dr. Ellen H. Boesen told Reuters Health, "psychotherapy to cancer patients is important for other reasons; in most studies, it increases quality of life and probably prevents the onset of depression."
Psychoeducation is a structured and time-limited program that provides patient education and psychological support, and teaches stress management and coping skills.
In the Journal of Clinical Oncology, Boesen of the Danish Cancer Society, Copenhagen, and colleagues sought to replicate a 1993 trial that had shown a beneficial effect on recurrence and survival in malignant melanoma patients at 6 years after a psychoeducational intervention.
In the current study, the researchers randomly assigned 262 patients with primary malignant melanoma to six 2-hour psychoeducation sessions or to a comparison group that received no intervention. For various reasons, four patients were excluded from the final analysis.
Four to 6 years after surgical treatment, 8 of 128 intervention patients had died versus 8 of 130 control patients. Recurrent disease was seen in 11 intervention and 7 control patients.
A further 137 eligible patients who declined to participate in the trial were also followed. Although no difference was observed in time to recurrence between these non-participants and the study participants, the non-participants had a more than two-fold increase in the risk of death.
The psychoeducational group, continued Boesen, "also had lower socioeconomic status. More notice should be taken in the psycho-oncology field to promote health behavior and adherence to treatment for the socially disadvantaged minorities."
In an accompanying editorial, Dr. David W. Kissane of Memorial Sloan Kettering Cancer Center, New York, agrees, noting that lower socioeconomic status is a factor "associated with poorer access to and perseverance with anticancer treatments."
He points out in his commentary that interventions are being refined "and do assuage many of the sources of distress that patients experience."
Nevertheless, he concludes that this and other studies "provide incontrovertible evidence that such psychotherapy interventions are not able to extend survival."
SOURCE: Journal of Clinical Oncology, December 20, 2007.