This study provides strong support for the efficacy of meaning-centered group psychotherapy as a treatment for psychological and existential or spiritual distress in patients with advanced cancer.
—William Breitbart, MD, and colleagues
In a randomized trial reported in the Journal of Clinical Oncology, William Breitbart, MD, of Memorial Sloan Kettering Cancer Center, and colleagues found that meaning-centered group psychotherapy significantly improved psychological well-being compared with supportive group psychotherapy in patients with advanced or terminal cancer.1
Developed by Dr. Breitbart and colleagues based on the work of Austrian neurologist and psychiatrist Viktor Frankl, MD, PhD, meaning-centered group psychotherapy is an eight-session manualized psychotherapy intervention designed to help patients develop or increase a sense of meaning in their lives by specifically addressing the loss of psychological and spiritual well-being and sense of meaning, which often occurs in patients with advanced cancer.
In the trial, 253 patients with advanced cancer from outpatient clinics at Memorial Sloan Kettering Cancer Center were randomly assigned between August 2007 and May 2012 to undergo a manual-based eight-session intervention of either meaning-centered group psychotherapy (n = 132) or supportive group psychotherapy (n = 121).
The primary outcome measures were spiritual well-being, assessed by the Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale, and overall quality of life, assessed by the McGill Quality-of-Life Questionnaire. Secondary outcome measures included depression (Beck Depression Inventory), anxiety (anxiety subscale of Hospital Anxiety and Depression Scale), hopelessness (Hopelessness Assessment in Illness Questionnaire), desire for hastened death (Schedule of Attitudes Toward Hastened Death), and physical symptom distress (Memorial Symptom Assessment Scale).
Analyses of treatment effects included the a priori covariates of sex, social support, cognitive functioning, and level of religiosity to control for potential confounding influences. Patients were assessed before and after completing the intervention and at 2 months after the intervention.
The meaning-centered group psychotherapy and supportive group psychotherapy groups were generally balanced for gender (71% and 68% female), age (mean, 57 and 60 years), race/ethnicity (71% and 67% white, 13% and 15% African American), religion (39% and 32% Catholic, 14% and 11% other Christian, 22% and 27% Jewish, 14% and 22% other, 11% and 8% none), primary cancer diagnosis (breast in 32% and 27%, pancreas in 14% and 22%, lung in 18% and 13%, colorectal in 16% and 15%, other in 21% and 22%), and Karnofsky performance score (mean, 83 and 82).
Overall, 70% of the meaning-centered group psychotherapy group and 65% of the supportive group psychotherapy group attended at least one session; of those who began treatment, 74% and 73% completed the post-treatment assessment. There was no significant difference between the groups in the mean number of sessions completed (5.55 and 5.28, P = .43).
Analyses including only patients who attended at least three sessions showed significant group X time interaction effects for all but one of the outcome measures, with significantly stronger treatment effects for meaning-centered group psychotherapy (all P < .05) being observed for quality of life (B value = 0.26), spiritual well-being (B = 0.26), depression (B = −0.28), hopelessness (B = −0.30), desire for hastened death (B = −0.23), and physical symptom distress (B = −0.22); no significant treatment effect was observed for anxiety symptom severity (B = −0.16, 95% confidence interval = −0.33 to 0.02).
A significant main effect for time (all P < .05) was observed for spiritual well-being, overall quality of life, depression, anxiety, hopelessness, and physical symptom distress, indicating improvement over time in these areas for all study patients. On intent-to-treat analysis excluding the a priori covariates, significantly greater benefit was still observed for meaning-centered group psychotherapy in quality of life, depression, and hopelessness but not for other outcome measures.
Significant within-group improvement after treatment was observed in the meaning-centered group psychotherapy group for spiritual well-being (d = 0.54, P < .001), quality of life (d = 0.40, P < .001), depression (d = −0.67, P < .001), anxiety (d = −0.52, P < .001), hopelessness (d = −0.53, P < .001), desire for hastened death (d = −0.31, P < .05), and physical symptom distress (d = −0.35, P < .01) and in the supportive group psychotherapy group only for depression (d = −0.34, P < .05).
At 2-month follow-up, the significant improvements persisted in the meaning-centered group psychotherapy group for spiritual well-being (d = 0.48, P < .001), quality of life (d = 0.35, P < .01), depression (d = −0.54, P < .001), anxiety (d = −0.36, P < .01), hopelessness (d = −0.55, P < .001), desire for hastened death (d = −0.27, P < .05), and physical symptom distress (d = −0.57, P < .001) and in the supportive group psychotherapy group only for depression (d = −0.39, P < .05).
The investigators concluded: “This large randomized controlled study provides strong support for the efficacy of meaning-centered group psychotherapy as a treatment for psychological and existential or spiritual distress in patients with advanced cancer.” ■
Disclosure: The study was supported by a grant from the National Cancer Institute. For full disclosures of the study authors, visit jco.ascopubs.org.
1. Breitbart W, Rosenfeld B, Pessin H, et al: Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. J Clin Oncol 33:749-754, 2015.
Study author William Breitbart, MD, of Memorial Sloan Kettering Cancer Center, offers further thoughts on the potential power of meaning-centered group psychotherapy in patients with advanced cancer.