Selecting a Support Group for Patients With Prostate Carcinoma

PHILADELPHIA--The burgeoning support group movement has much tooffer patients with prostate cancer. Professionals who wish torefer patients to a support group, or to start their own group,should be aware of the several types of groups that exist andwhat each can offer, said speakers at the American Cancer Society'sNational Conference on Prostate Cancer.

Studies have repeatedly demonstrated the effectiveness of supportgroups in improving the quality of life in patients with cancer,said Alice R. Kules, MSW, of Memorial Sloan-Kettering Cancer Center."There are many different types, and all are effective intheir own way."

When Dotti Calabrese, RN, began a support group for patients withcancer at the Cleveland Clinic Foundation, she learned that "thestereotypical presumptions of men in our society are changing.No longer do men feel that they have to be stoic, that they shouldn'tdiscuss their feelings or fears." Instead, these frank discussionsare viewed as a healthy response to stress.

Four Support Group Models

Ms. Kules described four of the major models for cancer supportgroups. Cognitive-behavioral groups teach skills such as behavioralmodification, relaxation techniques, focused deep breathing, visualization,and biofeedback, to relieve such problems as pain, nausea andvomiting, and anxiety.

In addition, cognitive techniques are taught to help patientscope with problems more effectively and develop a positive attitudeand a sense of empowerment. These groups are professionally led,with patients contributing their own feedback to help other groupmembers.

Psychotherapeutic support groups are closed-membership groupsof limited duration, ranging from 8 to 12 weekly sessions to aslong as a year, Ms. Kules said. These groups offer in-depth explorationof patients' emotional response to their cancer, an approach thatis not appropriate for all.

The groups deal with not only cancer-related anxiety and depressionbut also premorbid psychological problems that may have been exacerbatedby the diagnosis of cancer. Psychotherapeutic groups are highlyemotionally charged and require a professional leader.

Self-help groups, in contrast, are often led by patients, withoutthe involvement of a health professional. This type of supportgroup offers patients protection from isolation, shared informationon how to live with prostate cancer, motivation and encouragement,and a sense of control through active participation in a peer-ledgroup.

Ms. Kules helps provide a fourth type of support group, basedon the psychoeducational model. These groups offer patients bothinformation and emotional support. Her group at Memorial Sloan-Ketteringmeets for monthly 2-hour sessions, with an hour of education followedby an hour of discussion and support.

"These groups frequently appeal to patients who would notordinarily attend psychotherapeutic groups, but who still requirein-depth information and would like a supportive environment withwhich to share their concerns," she said. The open-endednessof this type of group allows patients to attend or not, dependingon their need and on their ability to travel to meetings.

The sessions are often co-facilitated by a physician, nurse, andsocial worker, providing a balance between information and emotionalcontent. "It is important to provide that balance, becausemen in these groups tend to focus on medical aspects, to avoidthe vulnerability that can be exposed when they talk about moreemotional content," Ms. Kules said.

Patients in such groups want two kinds of information, Ms. Calabresesaid: First, up-to-date facts about prostate cancer treatmentoptions, current research, and results; second, facts on how toimprove their quality of life. "They want information onsexuality, self-care strategies, and how to cope with hot flashesand other side effects," she said.

Four Models for Support Groups for Cancer Patients

Cognitive-behavioral groups--Teach skills such as behavioralmodification, relaxation techniques, focused deep breathing, visualization,and biofeedback, to relieve such problems as pain, nausea andvomiting, and anxiety; professionally led.

Psychotherapeutic support groups--Offer in-depth explorationof patients' emotional response to cancer; professionally led.

Self-help groups--Offer patients protection from isolation,shared information on how to live with cancer, motivation andencouragement, and a sense of control through active participationin a peer-led group.

Psychoeducational groups--Offer patients both informationand emotional support; co-facilitated by professionals.