Sisters For Life

Being told you have cancer is obviously news from hell. Hearing some time later that the cancer is advanced - that it's spread to another part of your body and will almost certainly kill you, perhaps within months - is worse still. Which is why it requires no great effort of the imagination to believe the statistic that at least 3 in 10 people who receive the latter diagnosis spend much of the balance of their life in a funk. "The fear that I have with this cancer," says Shinta, 48, whose disease has spread to her sternum and the lining of her lungs, "is the process of death. I don't want it to be long. I don't want my family to have to cope with it for a long time." For a cure, Shinta and thousands of Australians like her are at the mercy of medical science, the slim possibility that a miracle drug might be discovered in time to save them. Rather than obsess about that, Shinta chose to set the bar a little lower. In 2000, she joined a group of women - all with advanced breast cancer - engaged in a Melbourne-based trial of Supportive-Expressive Group Therapy, in which the participants meet weekly to discuss their cancer, including their treatment and innermost thoughts and feelings.

The results of the seven-year trial - which ended last year and involved several institutions, including the University of Melbourne - are still being analyzed. Researchers want to know two things. The first is whether SEGT improved the women's quality of life by staving off negative feelings and encouraging them to embrace the time they have left. On this level, neither the researchers nor most participants doubt that the therapy works. The more contentious - and intriguing - question is whether cancer patients who undergo SEGT might live longer than those who don't.

SEGT comes from the new field of psycho-oncology, which explores the role the mind might play in both causing and treating cancer. It remains on the fringe of medicine, and insofar as it delves into causation is likely to remain so: while stress has been shown to compromise the immune system, there's no strong evidence that these changes are significant in the development of cancer. But as a treatment adjunct, psycho- oncology is creeping into the mainstream. Self-help groups for cancer patients at all stages of the disease are common in Australia. But SEGT, the brainchild of American psychiatrist Irvin Yalom, differs from standard group therapy in several ways. Most importantly, a psychiatrist or psychologist leads the 90-min. sessions, working from the original premise of SEGT: that serious illness offers a chance for personal growth. "Much of life involves periods in which people drift somewhat aimlessly, taking life for granted," the three therapists involved in the Melbourne trial write in a new book, A Life to Live: A Group Journey with Advanced Breast Cancer (PsychOz Publications). "Only . . . when death is faced . . . does an authenticity emerge that brings with it the capacity to live life truly and fully."

A Life to Live is mostly the work of a group called the Thursday Girls, a subset of the 227 women who took part in the Melbourne trial. A dozen or so Thursday Girls still meet weekly at a Salvation Army center in Melbourne's eastern suburbs. Sitting around the kitchen table at the home of member Jeanette, three of them explain how the therapy helped them after the shattering diagnosis of metastatic breast cancer. "I was spiraling down," says Sally, 47, whose cancer reappeared in the original site and on her spine eight years after she thought she'd beaten it. "I'm coping enormously better now, purely and simply because I can go to this group, this sanctuary. You can say what you like. No one's going to ridicule you, no one's going to laugh at you, no one's going to do anything but support you." And it's liberating, say Shinta and Jeanette, to see that life goes on after the death of a group member; that families find ways to cope.