Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: psychological and immunological effects.
OBJECTIVE
Depression is particularly prevalent in patients with advanced cancer. Cognitive therapy (CT) is an empirically supported treatment for depression in the general population. However, efficacy remains to be demonstrated in patients with advanced cancer. A prior controlled trial of CT in a group format showed improvements in depression, mood disturbance, and self-esteem; however, these effects were not maintained over time. Studies examining the efficacy of individual format CT interventions that may ensure more long-term maintenance of benefits are necessary. This study assessed the efficacy of CT for depression administered individually in women with metastatic breast cancer and its effect on immune function.


METHODS
Forty-five women were randomly assigned to either individual CT or to a waiting-list control (WLC) condition. CT was composed of eight weekly sessions of CT and three booster sessions administered at 3-week intervals following the end of treatment.


RESULTS
Patients treated with CT had significantly lower scores on the Hamilton Depression Rating Scale at posttreatment compared to untreated patients. Pooled data from both groups indicated significant reductions of depressive symptoms from pre- to posttreatment, as well as reduction of associated symptoms including anxiety, fatigue, and insomnia symptoms. These effects were well sustained at the 3- and 6-month follow-up evaluations. CT for depression did not appear to have a significant impact on immune functioning.


CONCLUSIONS
Findings of this study support the efficacy of CT for depression in this population and suggest that the administration of individual and booster sessions after treatment termination may be instrumental in sustaining the treatment effects over time.
Savard
Josée
J
Laval University Cancer Research Center, Université Laval, Québec, Québec, Canada. josee.savard@psy.ulaval.ca
Simard
Sébastien
S
Giguère
Isabelle
I
Ivers
Hans
H
Morin
Charles M
CM
Maunsell
Elizabeth
E
Gagnon
Pierre
P
Robert
Jean
J
Marceau
Danièle
D
D001943:Breast Neoplasms / Q000276:immunology* / Q000473:pathology / Q000523:psychology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D016207:Cytokines / Q000378:metabolism; D003627:Data Interpretation, Statistical; D003863:Depression / Q000209:etiology / Q000276:immunology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007694:Killer Cells, Natural / Q000276:immunology; D008214:Lymphocytes / Q000276:immunology; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000276:immunology; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
D016207:Cytokines