Björneklett, H.G., Rosenblad, A., Lindemalm, C., Ojutkangas, M.L., Letocha, H., Strang, P., & Bergkvist, L. (2013). Long-term follow-up of a randomized study of support group intervention in women with primary breast cancer. Journal of Psychosomatic Research, 74(4), 346–353.

Long-term follow-up to evaluate quality of life after support group intervention in a randomized group of women with primary breast cancer presenting for postoperative radiotherapy.

The current study is a long-term follow-up 5–9 years after randomization into groups. The intervention and control groups were stratified by chemotherapy or nonchemotherapy treatment. The intervention was a one-week support group with four days of follow-up two months postintervention during residential care at the Foundation of Lustgården Mälardalen. The intervention involved lectures and group discussions about the etiology of cancer, risk factors, treatment, physical and psychological effects, and coping strategies. Patients engaged in physical exercise, relaxation, Qigong, and nonverbal communication exercises, as well as art and dance therapy. All participants completed questionnaires at baseline and follow-up questionnaires at 2, 6, and 12 months postintervention. The control group participated only in routine follow-up at the Department of Oncology or the Department of Surgery.

• N = 382 (final sample); 191 in intervention group and 191 in control group
• AGE RANGE: 30–83
• MALES: 0 %, FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Patients were newly diagnosed with primary breast cancer at the beginning of the parent study.

• SITE: Single site    
• SETTING TYPE: Outpatient   
• LOCATION: Department of Oncology at the Central Hospital in Västeräs, Sweden

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Palliative care 

• Prospective randomized trial
  • Long-term follow-up comparison of test scores at baseline, 12 months, and at end

• Hospital Anxiety and Depression Scale (HADS)
• European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)
• European Organisation for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23)
• Fatigue Questionnaire (FQ)

Fatigue symptoms improved over time, which was a significant finding in the intervention and control groups. Being upset about hair loss improved over time in the intervention group. High anxiety scores improved over time and were not significantly different between the two groups in long-term follow-up. Depression scores were high at follow-up for seven women in each group, and no significant difference was found at baseline and postintervention, adjusting for covariates. Neither group showed improvement between the 12-month follow-up and long-term follow-up. 

Effects of support group intervention may provide a sense of security that can fade over time, reversing improvements in anxiety and depression. Treatment-related fatigue may improve over time. Significant improvement was found in cognitive function, body image, and future perspective, but no significant effect was found on levels of anxiety and depression.

• An average of 6.5 years elapsed between the parent study and the follow-up study.
• Participants were lost to follow-up between the parent study and the follow-up study.
• No initial need for an intervention was conducted.

Women who have received chemotherapy have greater symptom severity and may benefit more on global health and cognitive function fatigue, when compared to women who have not received chemotherapy. Additional research is needed to evaluate the influence of exercise and psychosocial support interventions, according to patient needs for content, duration, and an assessment of spiritual well-being using the Functional Assessment of Chronic Illness Therapy (FACIT).