Meaning-based therapy may aid terminal patients

Friday, March 2, 2012

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NEW YORK (Reuters Health) - Psychotherapy focused on spirituality and finding meaning may help improve quality of life and well-being in terminally ill cancer patients, suggests a new study from a large cancer treatment center.

The talk therapy sessions only seemed to provide a short-term benefit -- though researchers said that was reasonable given that many of the study participants were near the end of their lives, with progressively worsening disease. The study's lead author said that while hospice and palliative care doctors and nurses are well-versed in treating pain and nausea, for example, there hasn't been definitive evidence on the treatment of non-physical symptoms in very ill patients.

"What palliative care clinicians have not had up until now are interventions that have shown some effectiveness in dealing with issues like loss of meaning, feeling demoralized (and) a loss of sense of spiritual well-being," said Dr. William Breitbart, from New York's Memorial Sloan-Kettering Cancer Center.

"This is a new tool," he told Reuters Health. "It gives more structure to what people are already attempting to do."

Breitbart said that many hospitals and hospices offer terminal patients access to a clergyman or chaplain, but meaning-centered discussions with a psychotherapist could be an option for patients who don't relate to a religious figure.

"This is a much more secular intervention based on a universal kind of language of meaning," he added.

In his team's study, 120 patients with stage 3 or 4 cancer -- most commonly breast or colon cancer -- were randomly assigned to attend seven hour-long sessions with a psychotherapist or to spend the same amount of time with a massage therapist.

The patients all had a prognosis that gave them less than six months to live, Breitbart said.

The psychotherapy sessions addressed issues of meaning, identity and hope, as well as the finiteness of life. They included reflection exercises and aimed to give patients a sense of peace and purpose in their lives, the researchers explained in their report, published Monday in the Journal of Clinical Oncology.

Scores on patient surveys of spiritual well-being -- including feelings of meaning and faith -- as well as quality of life and physical symptom distress all improved modestly but consistently in the therapy group from right before their first session to after their last.

There was little or no benefit seen over the same time span for patients who were treated with massage.

For example, quality of life scores measured on a scale of zero to 10 rose from an average 5.89 to 7.18 in the psychotherapy group, but only changed slightly from 6.55 to 6.78 among those who got massages.

Still, any improvement in talk therapy patients had largely disappeared by two months after their final session, when 67 participants remained in the study.

"With time, a lot of folks do get more and more debilitated, and some of the effects of the intervention get cancelled out by more progressive disease," Breitbart explained.

Both right after the psychotherapy sessions ended and two months later, cancer patients didn't show any significant improvements in anxiety, depression or hopelessness.

"Spiritual well-being is very focused around peace and meaning and purpose," Dr. Christina Puchalski, head of the George Washington Institute for Spirituality and Health in Washington, D.C., told Reuters Health.

"Things like anxiety and depression -- I think those are a little more complicated. People may have other needs for dealing with anxiety and depression, like medication or meditation," added Puchalski, a professor at The George Washington University School of Medicine who wasn't involved in the new study. Breitbart said he and his colleagues are in the midst of testing how well the talk therapy model works in a much larger group of patients and he's hopeful that it will become more widely used in the future.

"What's critical for cancer patients is for them to understand that even with advanced cancer, there is always the possibility for the experience of meaning, and creating meaning, even in the last days of life," he said.

SOURCE: http://bit.ly/z453YX Journal of Clinical Oncology, online February 27, 2012.

Reuters Health