Effectiveness of cognitive–behavioural therapy for depression in advanced cancer: CanTalk randomised controlled trial

Abstract

BackgroundDepression is one of the most common mental disorders in people with advanced cancer. Although cognitive–behavioural therapy (CBT) has been shown to be effective for depression in people with cancer, it is unclear whether this is the case for people with advanced cancer and depression.AimsWe sought to determine whether CBT is more clinically effective than treatment as usual (TAU) for treating depression in people with advanced cancer (trial registration number ISRCTN07622709).MethodA multi-centre, parallel-group single-blind randomised controlled trial comparing TAU with CBT (plus TAU). Participants (n = 230) with advanced cancer and depression were randomly allocated to (a) up to 12 sessions of individual CBT or (b) TAU. The primary outcome measure was the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, and Satisfaction with Care.ResultsMultilevel modelling, including complier-average intention-to-treat analysis, found no benefit of CBT. CBT delivery was proficient, but there was no treatment effect (−0.84, 95% CI −2.76 to 1.08) or effects for secondary measures. Exploratory subgroup analysis suggested an effect of CBT on the BDI-II in those widowed, divorced or separated (−7.21, 95% CI −11.15 to −3.28).ConclusionsUK National Institute for Health and Care Excellence (NICE) guidelines recommend CBT for treating depression. Delivery of CBT through the Improving Access to Psychological Therapies (IAPT) programme has been advocated for long-term conditions such as cancer. Although it is feasible to deliver CBT through IAPT proficiently to people with advanced cancer, this is not clinically effective. CBT for people widowed, divorced or separated needs further exploration. Alternate models of CBT delivery may yield different results.

A mixed methods pilot and feasibility open trial of internet-delivered cognitive behaviour therapy (iCanADAPT Advanced) for people with advanced cancer with depression and/or anxiety

“…The general positive direction on all measures is in keeping with the changes seen in a RCT of transdiagnostic iCBT in cancer survivors with clinical depression and/or anxiety ( Murphy et al, 2020 ). Moreover, the sample was more anxious than depressed with nearly all participants meeting the criteria for at least one anxiety disorder; this may be why the results are more in line with the recent randomized trial results of CBT-app for anxiety in advanced cancer ( Greer et al, 2019 ) showing that both CBT and psychoeducation provided benefit, rather than the results of face-to-face CBT for depression in advanced cancer ( Serfaty et al, 2019 ) which did not find a significant benefit for CBT over usual care. More in keeping with the transdiagnostic approach of this trial, a recent randomized trial ( n = 28) evaluated a three-session face-to-face CBT-ACT (acceptance-based cognitive behavioural -acceptance and commitment therapy) intervention versus waitlist.…”

“…Some recent reservation about the role of CBT in managing depression in advanced cancer has emerged since a recent RCT (CanTALK) ( Serfaty et al, 2019 ) of face-to-face CBT versus treatment-as-usual did not show a statistical benefit for the treatment of depression in advanced cancer. This is in contrast to recent RCT findings of Greer et al regarding their mobile application CBT (CBT-app) versus a control of generic health education (similar number of sessions, delivered via an app).…”

Personalized versus standard cognitive behavioral therapy for fear of cancer recurrence, depressive symptoms or cancer-related fatigue in cancer survivors: study protocol of a randomized controlled trial (MATCH-study)

“…Previous studies evaluated interventions for fear of cancer recurrence, depression, and fatigue in cancer survivors or patients with cancer [7][8][9][10][11][12]. The vast majority of these interventions are based on a cognitive behavioral model which assumes that although cancer and cancer treatment may trigger the psychological symptoms and fatigue, cognitive and behavioral factors subsequently perpetuate the symptoms [7,8,11].…”

“…Interventions targeting these perpetuating factors have been shown to decrease symptoms and improve functioning. However, effect sizes are mostly small and sometimes of a moderate magnitude, especially for the treatments aimed at fear of cancer recurrence and depressive symptoms [7,10,12]. Also, treatment effects are not always sustained at long-term follow-up [8] and attrition rates are relatively high [13].…”

Effects of magnanimous therapy on emotional, psychosomatic and immune functions of lung cancer patients

“…As a result, in recent years there have been calls for an effective and efficient approach to treatment, which combines physical and psychological techniques (Chang et al, 2012; Ferlay et al, 2010). Although some research indicates that cognitive behavioural therapy (CBT) appears not to be clinically effective for treatment of depression in people with advanced cancer (Lepore and Coyne, 2006; Serfaty et al, 2020), it is believed that psychological input remains an important part of the combined approach to lung cancer treatments (Huang, 2018).…”