Call for retraction of paper about Psychologic Intervention in cancer.

[barbc56]

I just happened upon a couple of articles debunking psychological interventions in cancer patients as far as improving survival. Even though they pertain to Cancer there are enough related issues that the me/cfs community deals with such as the lack of quality research, the political aspects of research the pace trial as well as the belief that me/cfs is psychological that make this thread worth posting.

I have included a lot of quotes as I think this is a very important topic. There are, of course, some very distinct differences between Cancer and me/cfs and hopefully I have addressed this at the end of this post.

This is the paper the author is talking about.

Psychological Intervention Improves Survival for Breast Cancer Patients

A formal request for retraction of a Cancer article.

I am formally requesting that Cancer retract an article claiming that psychotherapy delays recurrence and extends survival time for breast cancer patients. Regardless of whether I succeed in getting a retraction, I hope I will prompt other efforts to retract such articles.

You may recall my previously blogging about the article that I am now requesting be retracted. I described how the authors unsuccessfully attempted to block publication of a criticism of their study. They then refused to respond when the criticism was published. The article spun faulty analyses and avoided simple analyses that showed that giving cancer patients breathing exercises and encouragement of healthy behaviors does not forestall recurrence or extend their lives.

But earlier papers from the same project did some spinning as well. For instance, one paper tested the more reasonable hypothesis that psychological interventions can reduce emotional distress, improve health behaviors and dose-intensity, and enhance immune responses.

The NCI in particular provides financial support to efforts to promote psychoneuroimmunology in articles in special issues of journals and symposia that exclude any anyone who might express skepticism.

For political reasons, not science, the NIH is interested in keeping this line of research alive, even if it is on life support. The idea is that behavioral interventions can extend life, not just improve its quality. And to study exactly how requires not only investigator-initiated R01s but larger program grants. When the author of the Cancer article refused to respond to our critique, the task was accepted by Peter Kaufmann. He is the Deputy Chief of the Clinical Applications and Prevention Branch of National Heart Lung and Blood Institute (NHLBI) and at the time his commentary was written, President of the Society of Behavioral Medicine.

there is the lack of plausible biological mechanism by which group therapy could slow recurrence and extend survival.

You may ask why a claim for retraction is occurring at this time. First, the authors have continued to cite this claim in other publications without acknowledging objections to the analyses. Second, this paper continues to be widely cited and specifically as evidence that psychosocial intervention prolonged survival, a claim that does not otherwise have support. Third, this particular paper served as the basis for federal funding to disseminate training in this intervention. The paper is specifically cited in solicitations (http://tinyurl.com/n2den7g) for training at Professor Barbara Andersen’s Training Institute For Empirically Supported Biobehavioral Interventions for Cancer Patients.

These overall results suggest that what we were told in the abstract represents a gross confirmatory bias — the suppression of negative results and the highlighting of positive ones likely to be due to chance.

Claims about time to recurrence and cancer-specific and all-cause mortality are claims about biomedical outcomes. I seriously doubt that had such claims concerning chemotherapy or radiotherapy based on flawed analyses in a small sample in a study in which survival was not a predesignated outcome been made, they would go unchallenged. I believe that these authors’ claims should be held to the same standards as other biomedical interventions.

Wow, so we should ignore the lack of evidence for biologically-plausible mechanisms. Kaufmann suggests we should pour what would have to be millions of dollars into a trial to test whether psychotherapy and support groups extend the lives of cancer patients.

From The American Cancer Society:

The research is clear that support groups can affect quality of life, but the available scientific evidence does not support the idea that support groups or other forms of mental health therapy can by themselves help people with cancer live longer.

While there are very clear differences as far as the scientific knowledge about cancer vs. me/cfs, just the fact that there is mention of issues related to the pace trial are refreshing.

I would also hope that the fact that while support groups as well as psychological interventions only helping quality of life would not be interpreted as the same as CBC where a negative illness belief is addressed.

There is mention of individual therapy only improving quality of life, group support is more heavily weighted.

I think there are still a lot of positives in these articles that show a step in the right direction, even though they are baby steps.

Barb

ETA There are several other sources I want to cite but can't find them, (the second time today I have done this.). At this point I am exhausted (but worth it) and will return when I am refreshed to add these. I was so excited to see this refreshing point of view, I wanted to get this information out there ASAP. Who, me impatient?

 

[alex3619]

These articles about problems with supposed psychological intervention turn up (for cancer alone) from time to time. This is definitely not the first time.

 

[barbc56]

@alex3619

Interesting. From a quick glance of papers and the meta analysis of these type of studies, (I think is one of the articles that I can't find.), I thought it looked like the prevailing studies which were flawed according to this author, showed favorable results for psychological interventions beyond quality of life and even extending the life for cancer patients. But I could be overestimating? Is this what you are even saying? My brain is not functioning well atm.

I would think calling for an actual retraction of a paper like this would be unusual, although I did come across another cancer study that was being called to be retracted. I will try and find this.

But,as the author says, even if the retraction fails to happen, which is most likely, he is hoping other researchers will become more aware of this issue as his concern is the fact that other studies are citing the original study, "trainers" (not sure what the actual job description would be. Possibly social workers and therapists? :thumbdown:.) working with cancer patients as well as the funding for future research would be biased towards this view. This would foster an attitude that we deal with "blaming" the patient for not getting better.

His asking to have the study could be self serving and getting attention for the author but that's another subject

Sound familiar?

Thanks, Alex

Barb

 

[alex3619]

I am saying that grounds for rejecting poor science, spin and hype have occurred before in this area. It is not clear that this kind of approach works very well - psychological interventions can indeed help people cope, but help survival from a life threatening physical disease? Over time these kinds of claims tend to be disproved.

That is not to knock improved quality of life. Whether you have a limited survival time or a long one, better quality of life is desirable.

In cancer outcomes the long term survival is the key measure. However any confounds from the treatment etc. need to be taken into account.

Now I could see the use of doing something similar to the DALYs, and give data expressed as a function of both quality of life and survival time. That would be interesting to explore, and entirely novel so far as I am aware.

 

[Esther12]

Ta Barb. There's been some discussion here of Coyne's blogs about this previously (I think).

I don't know how much to expect as a response from this (tbh... probably not a lot)... although he clearly has a better shot at tidying things up than patients who also have to deal with the prejudices around CFS!

 

[barbc56]

@Esther12

Thanks. There are indeed several threads about Coyne on PR. I was not aware of this.

Barb

 

[Martial]

I am saying that grounds for rejecting poor science, spin and hype have occurred before in this area. It is not clear that this kind of approach works very well - psychological interventions can indeed help people cope, but help survival from a life threatening physical disease? Over time these kinds of claims tend to be disproved.

That is not to knock improved quality of life. Whether you have a limited survival time or a long one, better quality of life is desirable.

In cancer outcomes the long term survival is the key measure. However any confounds from the treatment etc. need to be taken into account.

Now I could see the use of doing something similar to the DALYs, and give data expressed as a function of both quality of life and survival time. That would be interesting to explore, and entirely novel so far as I am aware.

I think it would be useful in the sense it would strengthen the immune system and better cope with the physical stressors of treatment. Stress, anxiety, and depression can wreck an already weakened body. Also like you mentioned improving quality of life is indeed useful. To use a psychological approach to cure any physical disease alone is a different story.

 

[barbc56]

I think it would be useful in the sense it would strengthen the immune system and better cope with the physical stressors of treatment. Stress, anxiety, and depression can wreck an already weakened body. Also like you mentioned improving quality of life is indeed useful. To use a psychological approach to cure any physical disease alone is a different story.

It's my understanding psychological interventions only have a temporary effect on the immune system and those effects aren't at a therapuetic level. I'm thinking techniques such as meditation which I like to do, relaxation techniques listening to music yoga which certainly provide relaxation and give you a sense of well but not on the immune system. But it does make sense that stress can make health better or worse but again I'm not sure to what extent this involves the immune system.

It's a very in intriguing question.

Everything else yes, especially using psychological approaches without other interventions.

Take care.
Barb

 

[Martial]

It's my understanding psychological interventions only have a temporary effect on the immune system and those effects aren't at a therapuetic level. I'm thinking techniques such as meditation which I like to do, relaxation techniques listening to music yoga which certainly provide relaxation and give you a sense of well but not on the immune system. But it does make sense that stress can make health better or worse but again I'm not sure to what extent this involves the immune system.

It's a very in intriguing question.

Everything else yes, especially using psychological approaches without other interventions.

Take care.
Barb

Meditation and psychological intervention are two of the same modalities if it is done by a very conscious person, meditation grounds you deeper in reality and brings a deeper sense of stability and equilabrium in Self. However sometimes Pyschological Intervention is a form of Self Inquiry where people can remove false and limiting beliefs, thus less believing in their thoughts, less prone to stress. Etc..