282 Psychosocial Oncology
regard to reducing speci“c psychological (e.g., depression,
anxiety) and physical (e.g., anticipatory nausea and vomiting;
pain) cancer-related symptoms, as well as improving their
overall adjustment and emotional well-being. A logical next
question is: Do psychosocial interventions have any impact
on health outcome? For example, do they actually affect the
course or prognosis of the disease? As noted earlier, various
psychosocial variables have been found to be associated with
survival, such as coping and social support. Moreover, as
more research highlights the interplay between psychological
and medical symptoms (e.g., A. Nezu, Nezu, & Lombardo,
2001), such a question appears both legitimate and impera-
tive. For example, psychosocial treatments may affect the
course of cancer by (a) improving patient self-care (e.g.,
reduce behavioral risk factors), (b) increasing patients• com-
pliance with medical treatment, or (c) in”uencing disease re-
sistance regarding certain biological pathways, such as the
immune system (Classen, Sephton, Diamond, & Spiegel,
1998).
To date, the literature providing answers to this question
remains equivocal, that is, three studies provide data support-
ing the notion that psychosocial interventions extend the life
of cancer patients, whereas three investigations lacked an ef-
fect on survival. With regard to the “rst group of studies, the
investigation described by Spiegel et al. (1981) evaluating
the effects of supportive-expressive group therapy was not
originally designed to evaluate survival effects. However,
10 years after their study was completed, these authors col-
lected survival data for all participants (Spiegel, Bloom,
Kraemer, & Gottheil, 1989). To their admitted surprise,
women receiving the group therapy program lived an aver-
age of 36.6 months from time of initial randomization as
compared to the control patients who lived an average of
18.9 months. This difference was found to be both statisti-
cally and clinically signi“cant.
Similar to the Spiegel et al. (1981) study, the investigation
also previously described (Fawzy et al., 1993) with malig-
nant melanoma patients, was also not originally designed to
speci“cally assess dif ferences in survival rates as a function
of the differing experimental conditions. However, they did
“nd six years later that the treatment group experienced
longer survival as compared to control participants, as well as
a trend for a longer period to recurrence for the treated
patients (Fawzy et al., 1993).
Richardson, Shelton, Krailo, and Levine (1990) reported
on the effects of three treatment approaches geared to im-
prove treatment compliance for patients newly diagnosed
with hematologic malignancies: (a) education and a home
visit by a nurse; (b) education and a shaping program
designed to foster better adherence in taking medication;
and (c) education, shaping, and a home visit. With regard to
survival rates, these researchers found that assignment to any
of these treatment conditions, as compared to a control group,
signi“cantly predicted survival.
The three studies that found no difference on survival as a
function of participating in a psychosocial intervention in-
clude (a) a study that provided intensive individual supportive
counseling to men in a Veterans Administration hospital with
tumors across several sites (Linn, Lin, & Harris, 1982); (b) an
investigation that included 34 women with breast cancer who
participated in a program that provided individual counseling,
peer support, family therapy, and stress management training
(Gellert, Maxwell, & Siegel, 1993); and (c) a study that fo-
cused on the effects of three different supportive group therapy
conditions (Ilnyckyj, Farber, Cheang, & Weinerman, 1994).
In summary, whereas three studies provide no evidence to
support the enhanced survival rates for cancer patients re-
ceiving psychosocial treatment, three studies, in fact, do offer
such data. However, methodological issues across all these
investigations further add to the tentativeness of any “rm
conclusions (Classen et al., 1998).Effects of Psychosocial Interventions
on Immune FunctioningOne possible mediator of the positive effects of psychosocial
interventions on improved health, as well as emotional well-
being, is the immune system. In part, support for this hypoth-
esis emanates from research indicating alterations regarding
certain measures of immune functioning in humans experi-
encing stressful events (Herbert & Cohen, 1993), as well as
studies demonstrating changes in immune functioning as a
result of receiving psychosocial treatment. For example, the
study described earlier by Fawzy, Kemeny and colleagues
(1990) indicated that at the end of the six-week intervention,
patients receiving the treatment evidenced signi“cant in-
creases in the percentage of large granular lymphocytes. Six
months posttreatment, this increase in granular lymphocytes
continued and increases in natural killer cells were also evi-
dent. Relaxation training has also been found to lead to
higher lymphocyte counts and higher white blood cell
numbers even in cancer patients receiving myelosuppressive
therapy (Lekander, Furst, Rotstein, Hursti, & Fredrikson,
1997). Although research investigating the link between
immunologic parameters and psychosocial variables in
cancer patients is in its nascent stage and, therefore, can only
be viewed as suggestive at this time (see Bovbjerg &
Valdimarsdottir, 1998), such a framework provides an