Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer.

TitleMeta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer.
Publication TypeJournal Article
Year of Publication2012
AuthorsHart SL, Hoyt MA, Diefenbach M, Anderson DR, Kilbourn KM, Craft LL, Steel JL, Cuijpers P, Mohr DC, Berendsen M, Spring B, Stanton AL
JournalJ Natl Cancer Inst
Date Published2012 Jul 3
KeywordsAdaptation, Psychological, Adult, Antidepressive Agents, Cognitive Therapy, Confounding Factors (Epidemiology), Databases, Factual, Depression, Depressive Disorder, Major, Humans, Neoplasms, Problem Solving, Publication Bias, Randomized Controlled Trials as Topic, Risk Factors, Severity of Illness Index, Stress, Psychological, Treatment Outcome

BACKGROUND: Cancer patients are at increased risk for depression compared with individuals with no cancer diagnosis, yet few interventions target depressed cancer patients.

METHODS: Efficacy of psychotherapeutic and pharmacologic interventions for depression in cancer patients who met an entry threshold for depressive symptoms was examined by meta-analysis. Five electronic databases were systematically reviewed to identify randomized controlled trials meeting the selection criteria. Effect sizes were calculated using Hedges' g and were pooled to compare pre- and postrandomization depressive symptoms with a random effects model. Subgroup analyses tested moderators of effect sizes, such as comparison of different intervention modalities, with a mixed effects model. All statistical tests were two-sided.

RESULTS: Ten randomized controlled trials (six psychotherapeutic and four pharmacologic studies) met the selection criteria; 1362 participants with mixed cancer types and stages had been randomly assigned to treatment groups. One outlier trial was removed from analyses. The random effects model showed interventions to be superior to control conditions on reducing depressive symptoms postintervention (Hedges' g = 0.43, 95% confidence interval = 0.30 to 0.56, P < .001). In the four psychotherapeutic trials with follow-up assessment, interventions were more effective than control conditions up to 12-18 months after patients were randomly assigned to treatment groups (P < .001). Although each approach was more effective than the control conditions in improving depressive symptoms (P < .001), subgroup analyses showed that cognitive behavioral therapy appeared more effective than problem-solving therapy (P = .01), but not more effective than pharmacologic intervention (P = .07).

CONCLUSIONS: Our findings suggest that psychological and pharmacologic approaches can be targeted productively toward cancer patients with elevated depressive symptoms. Research is needed to maximize effectiveness, accessibility, and integration into clinical care of interventions for depressed cancer patients.

Alternate JournalJ. Natl. Cancer Inst.
PubMed ID22767203
PubMed Central IDPMC3634552
Grant List1R01CA133081 / CA / NCI NIH HHS / United States
5K07CA118576-02 / CA / NCI NIH HHS / United States
5K07CA134936-03 / CA / NCI NIH HHS / United States
UL1 RR025741 / RR / NCRR NIH HHS / United States
UL1 TR000150 / TR / NCATS NIH HHS / United States