Living with cancer: don't go it alone

Harvard Health Letter, Sept, 1997

Ten years ago support groups for people diagnosed with

cancer were often frowned upon or dismissed as "touchy-feely."

Many believed that talking about their feelings or

asking for help were signs of weakness. Some even feared

that meeting others with cancer would fuel depression and

self-pity.

Times have changed, however, and so have theories

about the value of talk.

Today more and more hospitals

are offering emotional support -- via

groups and one-on-one

counseling -- as part of the

standard treatment for cancer.

Earlier this year, the National

Cancer Institute together with two

other groups launched a

national campaign to raise

awareness of the vital role

emotional support plays in

enhancing quality of life for

people with cancer. Some

research suggests that support

may even increase longevity.

With a little help from strangers

It makes sense that emotional

support from a caring circle of

close friends or family would

buffer the stress suffered by

someone with cancer. But many

patients say they lack open

communication within their

families. As research and the

experiences of many people have

borne out, involvement in a support group comprised of others in

the same boat can fill a unique void.

Among the most telling studies was a 1989 investigation

led by Stanford University researchers. They evaluated 86

women with breast cancer that had already spread to other

parts of the body. Fifty of them attended weekly support

group meetings for at least a year in addition to receiving

standard medical treatment; 36 received only medical

interventions. Not surprisingly, women in the support

groups reported feeling less anxious, less depressed, and

less bothered by pain than the women who had not

participated in the meetings.

A more remarkable finding came to the fore years later.

The women in the support groups survived an average of

18 months longer than the others. In fact, four years after

the study began, one third of the participants in the

support groups were still alive, while all 36 of the other

women had died. This year the investigators reexamined

the medical records and death

certificates of the women and

found that such factors as

differences in medical treatment

did not account for the

discrepancy in survival rates

between the two groups. Some

experts believe this strengthens

the case for support groups.

The mind-body connection

How can emotional support

bolster the body's cancer

defense system? In 1990

investigators at the University

of Pittsburgh School of

Medicine found that breast

cancer patients who felt

emotionally supported had

highly active natural killer (NK)

cells -- white blood cells that are

normally present and capable of

destroying a wide variety of

tumor cells, including cancerous

ones. Support from a patient's

partner, close friend, or

physician was found to

have the most profound effect on NK cell activity.

Lending weight to the theory, in 1990 a study at the

UCLA/Neuropsychiatric Institute showed that people with

malignant melanoma who participated in group counseling

and education sessions for six weeks had reductions in

psychological distress, greater use of coping skills, and an

increase in the number and activity of NK cells six months

later. In addition, after five years the group members had

significantly better survival rates than their counterparts

who did not participate in the meetings.

Experts also speculate that emotional assistance confers

physical benefits by decreasing stress. Many

people with cancer, particularly those with poorly

controlled pain, are depressed. Depression overworks the

body's stress response system, causing it to regularly

produce increased levels of cortisol, a hormone that has

widespread effects in the body. Cortisol normally rises in

response to stress, and high levels suppress certain

functions of the immune system. It may be that participating

in a support group helps lift depression, thus reducing

oversecretion of this hormone.

A common bond

Cancer often isolates people at the very time they need

support the most. Well-meaning friends may distance

themselves from someone with cancer for fear of upsetting

the person or simply not knowing what to say. Likewise,

cancer can strain family relationships.

Those closest to the person with the disease are often

faced with financial worries, fear of the loved one's death,

more household responsibilities, and sometimes the role of

caregiver. Thus, for people with cancer, a group of peers

can be a place where they can vent some of their feelings

without suffering guilt about burdening an intimate partner

or friend.

Groups also bolster people's self-confidence. For

example, one of the women in the Stanford study told her

group about a recurrent nightmare in which she was lying

on a white slab with a group of

people in white coats peering down at her and trying to

pass a wire over her face. She felt the dream expressed the

frustration and helplessness she experienced when trying

to communicate with her doctors -- a theme echoed over

and over in cancer support groups. Her peers encouraged

her to assert herself and get the information she needed to