Manne, S.L., Ostroff, J.S., Winkel, G., Fox, K., Grana, G., Miller, E., . . . Frazier, T. (2005). Couple-focused group intervention for women with early stage breast cancer. Journal of Consulting and Clinical Psychology, 73, 634–646.

The intervention was a couple-focused support group intervention (90-minute group session over six weeks). The intervention consisted of enhanced support exchanges and coping skills between women with cancer and their partners. One group received the intervention and one group received usual care, which included social work consultations for all women and referral to a psychiatrist or psychologist if indicated. Assessments occurred initially, after the first group session, at the end of group session 6, and at six months for follow-up.

• The study reported on a sample of 238 women with early-stage breast cancer who had undergone surgery within the past six months and their partners.
• Patients had primarily ductal cancer (in situ, stage I, II, or IIIa), with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
• Patients were married or living with a significant other.
• Patients and partners were at least 18 years of age, able to give informed consent, and English speaking.

A longitudinal, randomized controlled trial design was used.

• Mental Health Inventory-18 (MHI-18) – anxiety subscale
• Impact of Event Scale
• Partner Unsupportive Behavior Scale
• Cancer Rehabilitation Evaluation System (CARES) – functional status subscale
• Expectancy Rating Form (modified) given after group session 1
• Borkovec and Naus’ Scale (expanded version) administered after group session 6
• Survey assessing use of psychosocial care
• Information on stage, treatment, and ECOG symptom ratings (obtained from medical chart; ECOG rating done by the patient’s physician)

Analysis evaluated subgroups of data using growth curves models approach with three-step procedure. For first step, time was considered the only explanatory variable. For second step, demographic, medical, site, treatment, and psychological covariates were examined. Third step examined moderator effects by crossing the intervention group main effect with time and the proposed mean-centered moderators. All multiple mean comparisons were adjusted with Tukey.

Women attending sessions reported significantly less distress and anxiety levels than did women receiving usual care or those who dropped out of the intervention (p = 0.0171). Findings suggest that women who rated their partners as more unsupportive and those who had greater physical impairment had an increased response to the intervention compared to women in the control group. Thirty-five percent dropped out of the intervention. Results via ITT analysis: First step (time) indicated significant decline in anxiety over time ([t344] = -2.21, p = 0.0280) and significant differences among participants both in preintervention anxiety (z = 8.02, p < 0.0001) and in the rates at which anxiety changed over time (z = 2.38, p = 0.0085). Second and third steps steps indicated that interactions involving the intervention group were not significant for anxiety. Effect sizes of intervention were small, ranging from 0.2 to 0.7.

Effect sizes were relatively small (0.2–0.7).