The Power of Human Attachment

Get Permission

For those patients with cancer who may be single, widowed, separated, or divorced, those for whom a natural social support system may be weak, the role of the cancer support group should not be overlooked. In leading a previous trial of supportive-expressive group therapy as a key pathway to foster social support, I found that patients who successfully connected with a cancer support group felt better supported and were more adherent with conventional anticancer therapy than those who did not.1

Major Debate

One conundrum not addressed in this article for The ASCO Post is why three earlier randomized controlled trials of supportive-expressive group therapy failed to extend survival.1-3 The question arises that if being married extends survival, which it clearly does, shouldn’t other forms of support also help in extending survival?  This has been a major debate in oncology.

In my editorial that accompanied the paper by Aizen et al,4,5 I suggested that the sample sizes in these group therapy studies were too small, that the cohorts should have targeted unmarried women, and that group support remains vital in cancer care, with the Aizen et al article stressing the importance of social support. The three group therapy trials had many married participants, which might have caused them to fail to show a survival benefit through a “ceiling effect.” That is, so many were well supported by already being married that the margin of gain for those who were single was masked.

Further, our supportive-expressive group therapy trial prevented the development of depression among its treated members compared to those receiving usual oncology care.1 Improving treatment adherence and preventing depression are such important goals of psycho-oncology. To achieve these goals, however, institutions need to open up staffing to include psychiatrists, psychologists, and social workers who can deliver these supportive services to patients.


The study by Aizer et al verifies the power of human attachment. It shows a relationship between marriage status and cancer survival, and perhaps serves as an important reminder to clinicians that a patient’s single status may be a red flag for poor social support. In such cases, referral to psycho-oncology services may be warranted.  Clinicians ought to be reminded of the importance of that 16th century axiom, “To cure sometimes, to relieve often, to comfort always (Anonymous).”

Targeted supportive programs are necessary to attend to those individuals most in need of social support and an opportunity for better quality of life and improved survival. ■

Dr. Kissane is a Recent Chairman of the Department of Psychiatry & Behavioral Sciences at Memorial Sloan-Kettering Cancer Center (2003-2012); Adjunct Professor of Psychiatry at Weill Cornell Medical College. He is currently Head of Discipline of Psychiatry and Chairman of the Department of Psychiatry, Monash University, Australia.

Disclosure: Dr. Kissane reported no potential conflicts of interest.


1. Kissane DW, Grabsch B, Clarke DM, et al: Suportive-expressive group therapy for women with metastatic breast cancer: Survival and psychosocial outcome from a randomized controlled trial. Psycho-Oncology 16:277-286, 2007.

2. Goodwin PJ, Leszcz M, Ennis M, et al: The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 345:1719-1726, 2001.

3. Spiegel D, Butler LD, Giese-Davis J, et al: Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: A randomized prospective trial. Cancer 110:1130-1138, 2007.

4. Aizer AA, Chen M-H, McCarthy EP, et al: Marital status and survival in patients with cancer. J Clin Oncol 31:3869-3876, 2013.

5. Kissane DW: Marriage is as protective as chemotherapy in cancer care. J Clin Oncol 31:3852-3853, 2013.

Related Articles

'Clear and Consistent Protective Effect of Marriage' Found in Patients With 10 Most Clinically Significant Cancers

A clear and consistent protective effect of marriage among patients harboring one of the 10 most clinically significant malignancies affecting Americans” was found in a study analyzing Surveillance, Epidemiology, and End Results (SEE) data for 734,889 patients diagnosed with lung, colorectal,...

SIDEBAR: Expect Questions About Support Systems for Unmarried Patients

The study finding that unmarried patients with cancer “are at significantly higher risk of presentation with metastatic cancer, undertreatment, and death resulting from their cancer,” generated a lot of comments from colleagues, family members, and patients, the study’s lead author Ayal A. Aizer,...