Level 2: Mid-level evidence

The efficacy of psychotherapeutic support was evaluated in a randomized trial of 271 patients having surgery for cancer of the liver/gallbladder, pancreas, colon/rectum, esophagus, or stomach (J Clin Oncol. 2007;25:2702-2708). Patients were randomized to support provided by psychotherapists during both pre- and postoperative hospital stay.

Psychotherapists provided emotional and cognitive support to foster a “fighting spirit” and to diminish “hopelessness and helplessness” and assisted the patient in planning for the future. Comparing psychotherapeutic support vs. usual care, there was 50.7% vs. 33.3% survival at two years (P=.002, NNT 6) and 21.3% vs. 9.6% survival at 10 years (P=.006, NNT 9). The authors of the trial did not reveal their methods for concealment of allocation during the enrollment process, so it is possible that true randomization did not occur.

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This department uses the best available scientific findings from around the world to offer practice guidance on a wide range of conditions seen in primary care. The author, Brian S. Alper, MD, MSPH, is the medical director of clinical reference products for EBSCO Publishing, Inc., in Ipswich, Mass., and editor-in-chief of DynaMed (www.dynamicmedical.com ), a database that provides evidence-based information on nearly 2,000 clinical topics and is updated daily through systematic surveillance covering more than 500 journals. The most important new research identified is used for this column.