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Psychotherapy for depression among advanced, incurable cancer patients: A systematic review and meta-analysis

  • Toru Okuyama
    Affiliations
    Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan

    Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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  • Tatsuo Akechi
    Affiliations
    Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan

    Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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  • Lisa Mackenzie
    Affiliations
    Priority Research Centre for Health Behaviour, School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia

    Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
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  • Toshi A. Furukawa
    Correspondence
    Corresponding author. Fax: +81 75 753 4641.
    Affiliations
    Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
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Published:April 10, 2017DOI:https://doi.org/10.1016/j.ctrv.2017.03.012

      Highlights

      • Effectiveness of psychotherapy for depression in advanced cancer patients was tested.
      • The result of meta-analysis indicated that psychotherapy was moderately effective.
      • Few studies focused on people with clinically diagnosed depression.

      Abstract

      Background

      There is a high prevalence of depressive disorder and depressive symptoms among advanced, incurable cancer patients. Patients commonly report a preference for non-pharmacological treatments such as psychotherapy over pharmacological treatments for depression. The objective of this review was to investigate the effectiveness of psychotherapy for the treatment of depression in people with advanced, incurable cancer via a meta-analysis of randomized controlled trials (RCTs).

      Methods

      We searched research databases and clinical trial registries for studies published prior to June 2015. No language restrictions were applied when selecting studies. Cochrane Collaboration meta-analysis review methodology was used. All relevant RCTs comparing psychotherapy with control conditions on depression outcomes for adults with advanced cancer were eligible for inclusion. We calculated pooled effect sizes using Hedges g and a standardized mean difference (SMD) of change between baseline and post-treatment scores. Quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

      Results

      Of 13 studies included in the review, 12 reported data suitable for meta-analysis. Psychotherapy was associated with moderate decrease in depression score (SMD −0.67, 95% confidence interval −1.06 to −0.29, P = 0.0005). Few studies focused on people with clinically diagnosed depression. Overall, quality of evidence across the included studies was rated as low, and heterogeneity was high.

      Conclusions

      Low quality evidence suggests that psychotherapy is moderately more effective for the amelioration of symptoms of depression among advanced, incurable cancer patients than the control conditions. There is insufficient high-quality evidence supporting the effectiveness of psychotherapy for patients with clinically diagnosed depression.

      Keywords

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      References

        • Mitchell A.J.
        • Chan M.
        • Bhatti H.
        • Halton M.
        • Grassi L.
        • Johansen C.
        • et al.
        Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies.
        Lancet Oncol. 2011; 12: 160-174
        • Block S.D.
        Assessing and managing depression in the terminally ill patient. ACP-ASIM end-of-life care consensus panel. American College of Physicians – American Society of Internal Medicine.
        Ann Int Med. 2000; 132: 209-218
        • Higginson I.J.
        • Costantini M.
        Dying with cancer, living well with advanced cancer.
        Eur J Cancer. 2008; 44: 1414-1424
        • Mathes T.
        • Pieper D.
        • Antoine S.L.
        • Eikermann M.
        Adherence influencing factors in patients taking oral anticancer agents: a systematic review.
        Cancer Epidemiol. 2014; 38: 214-226
        • Henriksson M.M.
        • Isometsa E.T.
        • Hietanen P.S.
        • Aro H.M.
        • Lonnqvist J.K.
        Mental disorders in cancer suicides.
        J Affect Disord. 1995; 36: 11-20
        • Rhondali W.
        • Chirac A.
        • Laurent A.
        • Terra J.L.
        • Filbet M.
        Family caregivers' perceptions of depression in patients with advanced cancer: a qualitative study.
        Palliat Support Care. 2014; 13: 1-8
        • Prieto J.M.
        • Blanch J.
        • Atala J.
        • Carreras E.
        • Rovira M.
        • Cirera E.
        • et al.
        Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation.
        J Clin Oncol. 2002; 20: 1907-1917
        • Pinquart M.
        • Duberstein P.R.
        Depression and cancer mortality: a meta-analysis.
        Psychol Med. 2010; 40: 1797-1810
        • Ostuzzi G.
        • Matcham F.
        • Dauchy S.
        • Barbui C.
        • Hotopf M.
        Antidepressants for the treatment of depression in people with cancer.
        Cochrane Database Syst Rev. 2015; 6
        • Lloyd-Williams M.
        • Payne S.
        • Reeve J.
        • Dona R. Kolamunnage
        Antidepressant medication in patients with advanced cancer – an observational study.
        QJM. 2013; 106: 995-1001
        • Okamura M.
        • Akizuki N.
        • Nakano T.
        • Shimizu K.
        • Ito T.
        • Akechi T.
        • et al.
        Clinical experience of the use of a pharmacological treatment algorithm for major depressive disorder in patients with advanced cancer.
        Psychooncology. 2008; 17: 154-160
        • Okuyama T.
        • Nakane Y.
        • Endo C.
        • Seto T.
        • Kato M.
        • Seki N.
        • et al.
        Mental health literacy in Japanese cancer patients: ability to recognize depression and preferences of treatments-comparison with Japanese lay public.
        Psychooncology. 2007; 16: 834-842
        • McHugh R.K.
        • Whitton S.W.
        • Peckham A.D.
        • Welge J.A.
        • Otto M.W.
        Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review.
        J Clin Psychiat. 2013; 74: 595-602
        • Corsini R.J.
        Introduction.
        in: Corsini R.J.W.D. Current psychotherapies. F.E. Peacock Publishers, Inc., Itasca Illinois2000: 1-4
        • O'Donovan A.
        • Casey L.
        • van der Veen M.
        • Boschen M.
        Psychotherapy: an Australian perspective.
        IP Communications, Hawthorn (Victoria, Australia)2013
        • Wheeler K.
        The nurse psychotherapists and a framework for practice.
        in: Wheeler K. Psychotherapy for the advanced practice psychiatric nurse: a how to guide for evidence-based practice. Springer Publishing Company, New York2014: 3-6
        • Faller H.
        • Schuler M.
        • Richard M.
        • Heckl U.
        • Weis J.
        • Kuffner R.
        Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis.
        J Clin Oncol. 2013; 31: 782-793
        • Hart S.L.
        • Hoyt M.A.
        • Diefenbach M.
        • Anderson D.R.
        • Kilbourn K.M.
        • Craft L.L.
        • et al.
        Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer.
        J Natl Cancer Inst. 2012; 104: 990-1004
        • Akechi T.
        • Okuyama T.
        • Onishi J.
        • Morita T.
        • Furukawa T.A.
        Psychotherapy for depression among incurable cancer patients.
        Cochrane Database Syst Rev. 2008; 2
        • Thase M.T.
        Psychotherapy of mood disorders.
        in: Gabbard G.O. Gabbard's treatments of psychiatric disorders. American Psychiatric Publishing, Washington (DC)2014: 221-248
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group P
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Ann Int Med. 2009; 151: W64
        • Lepper G.
        A pragmatic approach to the study of therapeutic interaction: toward an observational science of psychotherapy process.
        in: Gelo O.C.G. Pritz A. Rieken B. Psychotherapy research. Springer, Vienna2015: 517-534
        • Madill A.
        Conversation analysis and psychotherapy process research.
        in: Gelo O.C.G. Pritz A. Rieken B. Psychotherapy research. Springer, Vienna2015: 501-515
      1. Department of Health. Talking therapies: a four-year plan of action. <http://wwwiaptnhsuk/silo/files/talking-therapies-a-four-year-plan-of-actionpdf2011>.

        • Beck A.T.
        • Ward C.H.
        • Mendelson M.
        • Mock J.
        • Erbaugh J.
        An inventory for measuring depression.
        Arch Gen Psychiat. 1961; 4: 561-571
        • McNair D.M.
        • Lorr M.
        • Droppleman L.F.
        Edits manual for the profile of mood states.
        Edits/Educational and Industrial Testing Service, San Diego1992
      2. Association. AP. Diagnostic and statistical manual of mental disorders (DSM-IV), 4th ed. Washington: American Psychiatric Press; 1994.

      3. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2014.

      4. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011.

        • Furukawa T.A.
        From effect size into number needed to treat.
        Lancet. 1999; 353: 1680
        • Savović J.
        • Jones H.
        • Altman D.
        • Harris R.
        • Jűni P.
        • Pildal J.
        • et al.
        Influence of reported study design characteristics on intervention effect estimates from randomised controlled trials: combined analysis of meta-epidemiological studies.
        Health Technol Assess. 2012; 16: 1-82
      5. Schünemann H, Brożek J, Guyatt G, Oxman A. GRADE handbook. In: Group TGW, editor; 2013.

        • Classen C.
        • Butler L.D.
        • Koopman C.
        • Miller E.
        • DiMiceli S.
        • Giese-Davis J.
        • et al.
        Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial.
        Arch Gen Psychiat. 2001; 58: 494-501
        • Edelman S.
        • Bell D.R.
        • Kidman A.D.
        A group cognitive behaviour therapy programme with metastatic breast cancer patients.
        Psychooncology. 1999; 8: 295-305
        • Goodwin P.J.
        • Leszcz M.
        • Ennis M.
        • Koopmans J.
        • Vincent L.
        • Guther H.
        • et al.
        The effect of group psychosocial support on survival in metastatic breast cancer.
        N Engl J Med. 2001; 345: 1719-1726
        • Linn M.W.
        • Linn B.S.
        • Harris R.
        Effects of counseling for late stage cancer patients.
        Cancer. 1982; 49: 1048-1055
        • Spiegel D.
        • Bloom J.R.
        • Yalom I.
        Group support for patients with metastatic cancer. A randomized outcome study.
        Arch Gen Psychiat. 1981; 38: 527-533
        • Wood B.C.
        • Mynors-Wallis L.M.
        Problem-solving therapy in palliative care.
        Palliat Med. 1997; 11: 49-54
        • Laidlaw T.
        • Bennett B.M.
        • Dwivedi P.
        • Naito A.
        • Gruzelier J.
        Quality of life and mood changes in metastatic breast cancer after training in self-hypnosis or Johrei: a short report.
        Contemp Hypn. 2005; 22: 84-93
        • Liossi C.
        • White P.
        Efficacy of clinical hypnosis in the enhancement of quality of life of terminally ill cancer patients.
        Contemp Hypn. 2001; 18: 145-160
        • Sloman R.
        Relaxation and imagery for anxiety and depression control in community patients with advanced cancer.
        Cancer Nurs. 2002; 25: 432-435
        • Wu L.
        • Wang S.
        Psychotherapy improving depression and anxiety of patients treated with chemotherapy combined with radiotherapy.
        Chin J Clin Rehabil. 2003; 7: 2462-2463
        • Ando M.
        • Morita T.
        • Akechi T.
        • Okamoto T.
        Efficacy of short-term life-review interviews on the spiritual well-being of terminally ill cancer patients.
        J Pain Symptom Manage. 2010; 39: 993-1002
        • Breitbart W.
        • Poppito S.
        • Rosenfeld B.
        • Vickers A.J.
        • Li Y.
        • Abbey J.
        • et al.
        Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer.
        J Clin Oncol. 2012; 30: 1304-1309
        • Greer J.A.
        • Traeger L.
        • Bemis H.
        • Solis J.
        • Hendriksen E.S.
        • Park E.R.
        • et al.
        A pilot randomized controlled trial of brief cognitive-behavioral therapy for anxiety in patients with terminal cancer.
        Oncologist. 2012; 17: 1337-1345
        • Henry M.
        • Cohen S.R.
        • Lee V.
        • Sauthier P.
        • Provencher D.
        • Drouin P.
        • et al.
        The meaning-making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: a randomized controlled pilot study.
        Psychooncology. 2010; 19: 1340-1347
        • Kissane D.W.
        • Grabsch B.
        • Clarke D.M.
        • Smith G.C.
        • Love A.W.
        • Bloch S.
        • et al.
        Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial.
        Psychooncology. 2007; 16: 277-286
        • Rost A.D.
        • Wilson K.G.
        • Buchanan E.
        • Hildebrandt M.J.
        • Mutch D.
        Improving psychological adjustment among late-stage ovarian cancer patients: examining the role of avoidance in treatment.
        Cogn Behav Pract. 2012; 19: 508-517
        • Savard J.
        • Simard S.
        • Giguere I.
        • Ivers H.
        • Morin C.M.
        • Maunsell E.
        • et al.
        Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: psychological and immunological effects.
        Palliat Support Care. 2006; 4: 219-237
        • Zigmond A.S.
        • Snaith R.P.
        The hospital anxiety and depression scale.
        Acta Psychiatr Scand. 1983; 67: 361-370
        • Rayner L.
        • Price A.
        • Hotopf M.
        • Higginson I.J.
        The development of evidence-based European guidelines on the management of depression in palliative cancer care.
        Eur J Cancer. 2011; 47: 702-712
        • Uitterhoeve R.J.
        • Vernooy M.
        • Litjens M.
        • Potting K.
        • Bensing J.
        • De Mulder P.
        • et al.
        Psychosocial interventions for patients with advanced cancer – a systematic review of the literature.
        Br J Cancer. 2004; 91: 1050-1062
        • Penrod J.D.
        • Morrison R.S.
        Challenges for palliative care research.
        J Palliat Med. 2004; 7: 398-402
        • Manne S.
        • Andrykowski M.
        Are psychological interventions effective and accepted by cancer patients? II. Using empirically supported therapy guidelines to decide.
        Ann Behav Med. 2006; 32: 98-103
        • Lilienheld S.O.
        Psychological treatments that cause harm.
        Perspect Psychol Sci. 2007; 2: 53-70
        • Linden M.
        How to define, find and classify side effects in psychotherapy: from unwanted events to adverse treatment reactions.
        Clin Psychol Psychother. 2013; 20: 286-296
        • Jonsson U.
        • Alaie I.
        • Parling T.
        • Arnberg F.K.
        Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: a review of current practice.
        Contemp Clin Trials. 2014; 38: 1-8