Quality of Life and Anxiety in Breast Cancer Patients: The Effect of a Supportive-Expressive Group Therapy

Oncological Department, ASL 10 Florence, Psychoncological Group

Background Supportive–expressive group therapy has been reported1 to improve quality of life among cancer outpatients. The aim of this study is to assess the effects of participation in a supportive–expressive group therapy on anxiety and quality of life in breast cancer patients.Methods In a multicenter trial, we assign 60 women with metastatic breast cancer to an intervention group that will participate in weekly supportive–expressive group therapy (30 women) or to a control group that will receive no such intervention (30 women). All the women will complete a self-reported questionnaire before, during and after the intervention. The primary outcomes will be quality of life and anxiety scores.Intervention Women assigned to the intervention arm will participate in a weekly 90-minute therapist-led support group that adhered to the principles of supportive-expressive therapy2 for 8 months. Each group consist of ten to 15 women and two psychologists. The goals of Supportive–expressive group therapy have been well summarised as building bonds, expressing emotions, ‘detoxifying’ death and dying, redefining life’s priorities, fortifying families and friends, enhancing doctor–patient relationships and improving coping.Instruments The primary outcomes of quality of life and anxiety will be measured with use of the EORTC Quality of Life Questionnaire C30 (EORTC QLQ-C30)3 and State-Trait Anxiety Inventory form Y (STAI-FORM Y)4, respectively.The EORTC QLQ-C30 is widely used to study the quality of life in cancer patients and consists of 30 items. Twenty-four of the items form nine multi-item scales (six functional scales and three symptom scales) and six items are single-item symptom measures.The STAI–form Y is a brief self-rating scale for the assessment of state and trait anxiety, in adults. The STAI comprises separate self-report scales for measuring state (20 items) and trait (20 items) anxiety.Statistical Analysis Data and total scores on the EORTC QLQ-C30 and STAI–form Y will be analyzed using one-way ANOVA to compare the treatment and control groups at each time period. Regression equations and correlations will be performed to determine the impact of supportive-expressive group therapy on outcomes. Multivariate, repeated measures ANOVA will be used to analyze the main pre- and post-intervention effects and interactions both between and within groups.

1 Goodwin P et al. (2001) The Effect of Group Psychosocial Support on Survival in Metastatic Breast Cancer. The New England Journal of Medicine, 345(24); 1719-1726.2 Spiegel D, Spira J (1991) Supportive-expressive group therapy: A treatment manual of psychosocial intervention for women with recurrent breast cancer. Stanford, California, Stanford University School of Medicine.3 EORTC Quality Life Questionnaire C30, version 3.0 (1995). EORTC Study Group on Quality of Life.4 Spielberger CD (2005) State-Trait Anxiety Inventory for Adults. Redwood City, California, Mind Garden.