Meaning-Centered Group Psychotherapy Improves Psychological Well-Being in Patients With Advanced Cancer


Key Points

  • Among patients attending more than three sessions, meaning-centered group psychotherapy was associated with significantly greater benefit in quality of life, spiritual well-being, depression, hopelessness, desire for hastened death, and physical symptom distress compared with supportive group therapy.
  • Significant positive effects vs baseline in spiritual well-being, overall quality of life, depression, anxiety, hopelessness, and physical symptom distress were observed among all patients attending more than three sessions.

In a randomized trial reported in the Journal of Clinical Oncology, Breitbart et al found that meaning-centered group psychotherapy significantly improved psychological well-being compared with supportive group psychotherapy in patients with advanced or terminal cancer. Meaning-centered group psychotherapy is an eight-session manualized psychotherapy intervention developed by Breitbart and colleagues that is 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 loss of sense of meaning, which often occur 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 manualized eight-session interventions of meaning-centered group psychotherapy (n = 132) or supportive group therapy (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 gender, social support, cognitive function, 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 therapy 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).

Significant Improvements

Overall, 70% of the meaning-centered group psychotherapy group and 65% of the supportive group therapy 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 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 × time interaction effects for all but one of the outcome measures, with significantly stronger treatment effects for meaning-centered group psychotherapy being observed for quality of life, spiritual well-being, depression, hopelessness, desire for hastened death, and physical symptom distress; no significant treatment effect was observed for anxiety symptom severity. A significant main effect for time 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.

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.”

William Breitbart, MD, of Memorial Sloan Kettering Cancer Center, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by a grant from the National Cancer Institute.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.