Cognitive behavioral symptom management intervention in patients with cancer: survival analysis

Associations between psychological factors and cancer survival have been under debate. We retrospectively explored the effect of the Cancer Care Intervention (CCI), an individually delivered cognitive behavioral symptom management intervention on survival in individuals with cancer. Data were obtained from a randomized controlled trial (R01 CA79280; 1997-2003) that were originally designed to evaluate the CCI to reduce symptom severity in 237 individuals with solid tumors during their first course of chemotherapy. Participants were randomized into: (1) ten-contact, 20-week CCI plus usual care (n = 118) and (2) usual care only (n = 119). Survival data as of June 2009 were censored based upon Social Security Death Index. Participants were mostly female (73.4%), Caucasian (92.8%), and 59.6 +/- 10.5 years old. Breast (38.8%) and lung (35%) cancer were the most common cancer types. At enrollment, 66.7% of the participants had cancers at stage III or greater. Overall mortality was 53.2% (126 of 237). The CCI did not significantly affect survival (median survival, CCI = 88 months; usual care = 53.3 months; log rank = 0.30, p = 0.58). Age, stage of cancer, and surgical removal of the tumor were the only factors significantly associated with survival. Post hoc analysis stratified by cancer site and gender (women with breast cancer, women with lung cancer, men with lung cancer, and others) showed no survival effect from the CCI. In this analysis, the CCI was not associated with better survival. For future research, studies exploring survival outcomes need to consider specific characteristics of each intervention and cancer type.