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      Depressive Spectrum Disorders in Cancer: Diagnostic Issues and Intervention. A Critical Review

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          Abstract

          Depressive spectrum disorders, including major depression, persistent depression, minor and sub-syndromal depression, and other forms of depressive conditions, such as demoralization, are among the most common psychiatric consequences of cancer patients, affecting up to 60% of patients. In spite of the negative effects and the burden for cancer patients and their families, these disorders often remain under-recognized and undertreated. The present review aims at summarizing the relevant data concerning the diagnostic challenges within the depressive spectrum disorders among cancer patients. Also, the most relevant data relative to integrated intervention, including psychopharmacological and psychosocial treatment, for depression in cancer patients are critically evaluated. It is mandatory that health care professionals working in oncology (e.g., oncologists, surgeons, radiation oncologists, primary care physicians, nurses, social workers, psychologists) receive training in the diagnosis and integrated management of the different types of disorder within the spectrum of clinical depression.

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          The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: a systematic review and meta-analysis.

          Robert Zachariae, Jacob Piet, Hanne Würtzen (2012)
          The use of mindfulness-based therapy (MBT) in oncology settings has become increasingly popular, and research in the field has rapidly expanded. The objective was by means of a systematic review and meta-analysis to evaluate the current evidence for the effect of MBT on symptoms of anxiety and depression in adult cancer patients and survivors. Electronic databases were searched, and researchers were contacted for further relevant studies. Twenty-two independent studies with a total of 1,403 participants were included. Studies were coded for quality (range: 0-4), and overall effect size analyses were performed separately for nonrandomized studies (K = 13, n = 448) and randomized controlled trials (RCTs; K = 9, n = 955). Effect sizes were combined using the random-effects model. In the aggregated sample of nonrandomized studies (average quality score: 0.5), MBT was associated with significantly reduced symptoms of anxiety and depression from pre- to posttreatment corresponding to moderate effect sizes (Hedges\'s g) of 0.60 and 0.42, respectively. The pooled controlled effect sizes (Hedges\'s g) of RCTs (average quality score: 2.9) were 0.37 for anxiety symptoms (p < .001) and 0.44 for symptoms of depression (p < .001). These effect sizes appeared robust. Furthermore, in RCTs, MBT significantly improved mindfulness skills (Hedges\'s g = 0.39). While the overall quality of existing clinical trials varies considerably, there appears to be some positive evidence from relatively high-quality RCTs to support the use of MBT for cancer patients and survivors with symptoms of anxiety and depression.
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            Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses.

            Michael Feuerstein, Jennifer Osborn, Angelique Demoncada (2005)
            The purpose of this meta-analysis was to investigate the effects of cognitive behavioral therapy (CBT) and patient education (PE) on commonly reported problems (depression, anxiety, pain, physical functioning, and quality of life (QOL)) in adult cancer survivors. Meta analyses of randomized controlled trials of CBT and PE were conducted. MEDLINE, PSYCHINFO and the Cochrane Database were searched from 1993-2004. The effects of individual versus group interventions and short ( 8 months) term follow up are also reported. Fifteen studies met quality criteria. The sample size was 1,492 adult cancer survivors with an age range of 18-84. 790 were randomly assigned to intervention groups and 702 to control groups. CBT varied in duration from 4 weekly one-hour sessions to 55 weekly two-hour sessions. PE ranged from a single 20-minute session to 6 weekly one-hour sessions. Follow up ranged from 1 week to 14 months. CBT was effective for depression (ES = 1.2; 95% CI = 0.22-2.19), anxiety (ES = 1.99; 95% CI = 0.69-3.31), and QOL (ES = 0.91; 95% CI = 0.38-1.44). QOL was improved at both short and (ES = 1.45, 95% CI = .43-2.47) and long term (ES = .26; 95% CI = .06-.46) follow up. PE was not related to improved outcomes. CBT is related to short-term effects on depression and anxiety and both short and long term effects on QOL. Individual interventions were more effective than group. Various CBT approaches provided in an individual format can assist cancer survivors in reducing emotional distress and improving quality of life.
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              Systematic review of psychological therapies for cancer patients: overview and recommendations for future research.

              S Newell, R Sanson, Nina Savolainen (2002)
              Many cancer patients use psychological therapies because they expect them to cure their cancer or to improve their recovery. Despite these high expectations, both patients and oncologists report being moderately to very satisfied with the results of psychological therapies. Previous reviews of the literature have concluded that psychological therapies may help cancer patients in various ways, ranging from reducing the side effects of cancer treatments to improving patients' immune function and longevity. However, because those reviews lacked methodologic rigor, we critically and systematically reviewed all identifiable publications about psychological therapies used by cancer patients to provide an objective and scientific evaluation of nontraditional therapies. We identified 627 relevant papers that reported on 329 intervention trials by searching MEDLINE, Healthplan, Psychlit, and Allied and Complementary Medicine databases and in the bibliographies of the papers identified. Despite increased use of randomized, controlled trial designs over time, the methodologic quality of the intervention trials, on 10 internal validity indicators, was generally suboptimal, with only one trial achieving a quality rating of "good" for its methodology. Using effectiveness results from 34 trials with psychosocial outcomes, 28 trials with side effect outcomes, 10 trials with conditioned side-effect outcomes, and 10 trials with survival or immune outcomes, we make only tentative recommendations about the effectiveness of psychological therapies for improving cancer patients' outcomes. Nevertheless, by exploring the relative effectiveness of the different intervention strategies for each outcome and follow-up period, we suggest the specific therapies that should be considered for further investigation. In addition, we suggest how future trials can maximize their internal validity by describing the minimal reporting standards that should be required in this field.
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                Author and article information

                Contributors
                Luigi Grassi: +39 0532 236809 , luigi.grassi@unife.it
                Journal
                Journal ID (nlm-ta): Curr Psychiatry Rep
                Journal ID (iso-abbrev): Curr Psychiatry Rep
                Title: Current Psychiatry Reports
                Publisher: Springer US (New York )
                ISSN (Print): 1523-3812
                ISSN (Electronic): 1535-1645
                Publication date (Electronic): 9 May 2017
                Publication date PMC-release: 9 May 2017
                Publication date (Print): 2017
                Volume: 19
                Issue: 6
                Electronic Location Identifier: 33
                Affiliations
                [1 ]ISNI 0000 0004 1757 2064, GRID grid.8484.0, Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, , University of Ferrara, ; Via Fossato di Mortara 64a, 44121 Ferrara, Italy
                [2 ]GRID grid.416315.4, University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, , S. Anna University Hospital and Health Authorities, ; Ferrara, Italy
                [3 ]ISNI 0000000086837370, GRID grid.214458.e, , Department of Psychiatry, University of Michigan, ; Ann Arbor, MI USA
                [4 ]ISNI 0000 0000 9081 2336, GRID grid.412590.b, , University of Michigan Comprehensive Cancer Center, ; Ann Arbor, MI USA
                [5 ]ISNI 0000 0000 9081 2336, GRID grid.412590.b, , Psycho-oncology Program, University of Michigan Comprehensive Cancer Center, ; Ann Arbor, MI USA
                Author notes

                The editors would like to thank Dr. Kamalika Roy for taking the time to review this manuscript.

                Article
                Publisher ID: 785
                DOI: 10.1007/s11920-017-0785-7
                PMC ID: 5423924
                PubMed ID: 28488207
                SO-VID: d728b840-edf3-47e1-b4f0-c53d10fc9721
                Copyright © © The Author(s) 2017
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Categories
                Subject: Complex Medical-Psychiatric Issues (MB Riba, Section Editor)
                Custom metadata
                issue-copyright-statement © Springer Science+Business Media New York 2017

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: psychiatry,depression,cancer,psychopharmacology,antidepressants,psychotherapy
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: psychiatry, depression, cancer, psychopharmacology, antidepressants, psychotherapy

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