The mind-cancer survival question

There has been much interest in the controversial possibility that psychosocial interventions might be used to prolong the survival of cancer patients. See, for example: The mind – body connection and cancer: Can support groups help me live longer? (Oral Cancer Foundation, undated). Excerpt:

Groups have become popular as a means of support among patients. They got an enormous boost in 1989 when Dr. David Spiegel, a psychiatrist at Stanford University, reported a ten-year study showing that women receiving standard treatment for metastatic breast cancer who had participated in group therapy lived longer by an average of eighteen months. The study was not originally designed to look at survival, and the women were never told that group sessions might influence their survival. Published in the British medical journal Lancet, this study created a great stir in the medical community and among patients. …

This topic is of great interest to lay readers. For example, a search of the Breast Cancer Mailing List Archives for the key words ‘David Spiegel’ yielded almost 200 messages. [A sidebar: research involving messages sent to such mailing lists raises issues of Internet research ethics about ‘list mining‘].

In view of the great interest (especially from a lay perspective) in research on psychosocial oncology, one might hope that a high proportion the relevant research articles would be OA. They aren’t.

One example: the Journal of Psychosocial Oncology isn’t an OA journal. (However, according to information available via the section on ‘Preprint Distribution Rights’ of the Publication Agreement of Haworth Press, Green OA is permitted – that is, authors can archive the preprint, and can replace it with the final draft post-refereeing. A summary of this policy is also available via the SHERPA/RoMEO website).

Another example is provided by the article mentioned in the above excerpt. It’s: Effect of psychosocial treatment on survival of patients with metastatic breast cancer, by Spiegel D, Bloom JR, Kraemer HC, Gottheil E, Lancet 1989(14 Oct); 2(8668): 888-91. Only the Abstract is freely accessible, via the Elsevier Article Locator.

The first author, David Spiegel, is a member of the Stanford Cancer Center. A list of publications provides access to the abstracts of each published article (but not to the full text).

A PubMed search for articles authored by David Spiegel yielded a set of 109 articles. Of these, 8 were identified by PubMed to permit, at present, free access to the full text. Of the most recent 20 articles, only one is identified as providing free access to the full text. Of these first 20 articles, Google Scholar and Google searches yielded free access to the full text of one additonal article (2/20 = 10%).

However, articles co-authored by Janine Giese-Davis can be accessed via the publications of Janine Giese-Davis, after a login/password for a downloadable publication has been obtained from the author via email.

The current version of her webpage hasn’t been updated yet to include access to a recently-published article, “Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer : a randomized prospective trial”, by David Spiegel, Lisa D. Butler, Janine Giese-Davis and colleagues, Cancer 2007; 110(5): 1130-38 (Epub Jul 23). A PubMed abstract is available, but a subscription is required to access the full text. An excerpt (Conclusions):

The earlier finding that longer survival was associated with supportive-expressive group therapy was not replicated. Although it is possible that psychosocial effects on survival are relevant to a small subsample of women who are more refractory to current hormonal treatments, further research is required to investigate subgroup differences.

A news release about this publication is: Support groups don’t extend survival of metastatic breast cancer patients, Stanford study finds, Stanford University Medical Center, 22 July, 2007.

A commentary about this same article is: Group Therapy Fails To Improve Breast Cancer Survival, by David Sampson, Director, Medical & Scientific Communications, American Cancer Society (23 July 2007).

How about access to relevant recent reviews? There’s a recent OA review: The effect of psychosocial factors on breast cancer outcome: a systematic review, by Matthew E Falagas and five colleagues (Breast Cancer Research 2007; 9: R44). It’s identified as a ‘highly accessed‘ OA article. Excerpt (Conclusion):

Most of the studies show a significant relationship between psychosocial factors and survival, but the actual psychosocial variables related to survival are not consistently measured across studies and the findings for many of the psychosocial variables with survival/recurrence are not consistent across studies. Thus, more research is warranted regarding the role of social support, marriage, minimizing and denial, depression and constraint of emotions on breast cancer survival.

Another recent review isn’t OA. It’s:What is the state of the evidence on the mind-cancer survival question, and where do we go from here? A point of view, by Joanne Stephen, Michelle Rahn, Marja Verhoef, Anne Leis, Support Care Cancer 2007(Aug); 15(8): 923-30. Epub 2007 Jun 26. This is a Springer journal, and only the Abstract is freely accessible. (See also the Abstract in the BioInfoBank Library).

An excerpt from the Abstract:

Some researchers view the mind-cancer survival question as resolved and negative, whereas others identify conceptual and methodological challenges and view the possible impact of psychosocial factors on survival as simply unproven. We take the position that the question is unanswered.

It seems likley that there will be additional attempts made to answer the question. Those who attempt to do so should be encouraged to provide open access to their peer-reviewed publications.

Still uncertain about how to do this? For a brief summary of several options that are available, see an item in Biology Library News, Washington University in St. Louis (23 August 2007). This news item includes a link to a summary of the relevant issues. The options that are listed don’t explicitly include the ‘request a login/password’ approach built into the publications page of Janine Giese-Davis.

Not all of these options provide optimal access. However, they are compatible with the goal of John Willinsky’s book: ‘incremental advances in the circulation of knowledge’.



  1. tillje said

    There’s a total of 46 references cited in the OA review, The effect of psychosocial factors on breast cancer outcome: a systematic review, by Matthew E Falagas and co-authors, Breast Cancer Research 2007; 9: R44. Of the 30 references to journal articles published between 1996 and 2007, I was able to obtain free access, without a subscription, to 12 (40%). All were published before 2005.

  2. tillje said

    There’s an interesting and relevant article in J Support Oncol 2007(Apr); 5(4): 185–193, “Leveling the Playing Field: The Personal Coach Program as an Innovative Approach to Assess and Address the Supportive Care Needs of Underserved Cancer Patients”, by Joanne Hohenadel, Elizabeth Kaegi, Jack Laidlaw, Galina Kovacik, Andrea Cortinois, Rita Kang and Alejandro R. Jadad. Excerpts from the Abstract:

    Supportive care addresses informational, social, emotional, spiritual, physical, and practical needs that impact the lives of patients and their families. Accessing supportive care services is particularly challenging for patients facing significant financial and social barriers. This report discusses the Personal Coach Program (PCP), which provides specially trained coach navigators of supportive care for cancer patients, with special focus on those facing the above-mentioned barriers.

    Participants were highly satisfied with the program and believed it had positive implications for both physical and emotional health. Based on these results, a demonstration model for a supportive-care program is proposed as an integral component of care for all cancer patients, including those at risk for underservice.

    The free full text of this article can be downloaded [PDF, 227 kb].

    An excerpt from the full text:

    Effect on disease outcomes

    In this study, several services provided by coaches could affect disease outcomes directly by promoting adherence to treatment – helping patients to get prescribed drugs, assisting them to prepare for and attend appointments, arranging for interpreters for appointments, and providing access to understandable information about cancer and its management. However, the time frame for this study was too short to allow formal evaluation of disease outcomes; such an evaluation should be a focus of a future study.

    The Journal of Supportive Oncology is a subscription-based Elsevier journal.

    Added September 12, 2007:

    The Journal of Supportive Oncology is one of the journals that’s included on the OncologySTAT All Journals Page.

    For a relevant post, see also: OncologySTAT portal for cancer research, September 11, 2007.

  3. tillje said

    More about the mind-cancer survival question: Letting Go of the Hope That Psychotherapy Prolongs Cancer Survival, an editorial by David W. Kissane, Journal of Clinical Oncology 2007(Dec 20); 25(36): 5689-5690.

    The editorial is about an article, Survival after a psycho-educational intervention for patients with cutaneous malignant melanoma: A replication study, by Ellen H. Boesen and 8 co-authors, J Clin Oncol 2007(Dec 20); 25(36): 5698-5703. Excerpt from the abstract:

    Conclusion: Psychoeducation did not increase survival or the recurrence-free interval among patients with malignant melanoma; however, nonparticipants had a statistically significantly greater risk for death than participants.

    The full text of the editorial is freely accessible.

  4. […] The mind-cancer survival question « Be openly accessible or be … – Groups have become popular as a means of support among patients. They got an enormous boost in 1989 when Dr. David Spiegel, a psychiatrist at Stanford University, reported a ten-year study showing that women receiving … […]

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