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Unformatted text preview: Time to Let Go of the Illusion That Psychotherapy Extends the Survival of Cancer Patients: Reply to Kraemer, Kuchler, and Spiegel (2009) James C. Coyne University of Pennsylvania School of Medicine Brett D. Thombs McGill University and Jewish General Hospital Michael Stefanek American Cancer Society Steven C. Palmer University of Pennsylvania School of Medicine The authors recently reviewed evidence related to the notion that psychotherapy extends survival in cancer patients (J. C. Coyne, M. Stefanek, & S. C. Palmer, 2007). The authors found that no study to date, including several designed and powered to test this hypothesis, can be reasonably interpreted as evidence that cancer patients live longer as a result of receiving psychotherapy. The authors concluded that the evidence against psychotherapy as a life-prolonging intervention in cancer is sufficiently robust to discontinue funding studies in this area. H. C. Kraemer, T. Kuchler, and D. Spiegel (2009) critiqued the authors review. The authors respond directly to numerous misrepresentations made by Kraemer et al. More importantly, the authors provide readers with an accurate overview of the main issues being debated and the reasons for their conclusions. Keywords: cancer, psychotherapy, survival, mortality We anticipated that our review (Coyne, Stefanek, & Palmer, 2007) of claims that psychotherapy prolongs the survival of cancer patients would meet with disapproval, but we were unprepared for the degree to which Kraemer, Kuchler, and Spiegel (2009) mis- represented our work. Many of their complaints seem quite trivial, such as stating cointervention is not a word in English (Kraemer et al., 2009, p. 175); 1 others build and eviscerate straw-man arguments about methodology. Readers should consider our re- view and decide for themselves. Briefly, we reexamined studies that Spiegel and Giese-Davis (2004) identified as relevant and concluded that none could be reasonably interpreted as evidence that cancer patients live longer as a result of psychotherapy. Spiegel, Bloom, Kraemer, and Gottheils (1989) original study was not designed to test whether psychotherapy affected survival; survival was not a primary endpoint, and the results were unan- ticipated. With a small control group ( n 5 36), randomization often fails to equalize baseline characteristics. Spiegel et al. (2007) later noted difficulties achieving equalization with groups twice as large. Indeed, Kraemer, Gardner, Brooks, and Yesavage (1998) argued that results from such small studies are too unreliable and should not be included in meta-analyses. For intervention trial results to be generalizable, one must as- sume that, absent intervention, outcomes in the intervention group would be similar to the control group. Survival in Spiegel et al.s (1989) study did not begin to diverge until 2 years after random- ization, when control group participants began to die at higher than expected rates. One would have expected 32% survival at 510expected rates....
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- Spring '08