The ‘CALM’ Approach to Relieving and Preventing Depression in Advanced Cancer

Use of a brief psychotherapeutic intervention-called Managing Cancer and Living Meaningfully, or “CALM,”-provided a systematic approach to alleviating depressive symptoms in patients with advanced cancer, according to results of a clinical trial that tested this intervention.

“The findings of this RCT suggest that CALM therapy may help to relieve and prevent depressive symptoms in individuals with advanced disease and help patients to address preparations for the end of life,” Gary Rodin, MD, of Princess Margaret Cancer Centre, and colleagues wrote in the Journal of Clinical Oncology. CALM is a novel, brief, manualized intervention designed to treat and prevent depression and end-of-life distress in patients with advanced cancer. According to the study, “CALM provides a therapeutic relationship and reflective space, with attention to the following domains: symptom management and communication with health care providers, changes in self and relations with close others, spiritual well-being and the sense of meaning and purpose, and mortality and future-oriented concerns.”

Previous studies of CALM showed that the intervention improved depression, anxiety regarding death, and spiritual well-being.

The trial included 305 participants with advanced cancer who were recruited from outpatient oncology clinics at a comprehensive cancer center. Participants were randomly assigned to CALM plus usual care or usual care alone. Assessments of depressive symptoms were done at baseline, at 3 months, and at 6 months.

At least 50% of the 305 enrollees participated in at least three sessions of CALM at 3 months, increasing to 77.5% by 6 months. At both 3 months (P = .04) and 6 months (P = .02), participants assigned to CALM reported less-severe depressive symptoms than participants assigned to usual care.

The researchers also found a significant treatment effect for preparation for end of life at both 3 months and 6 months in CALM participants, compared with those randomized to usual care. After controlling for multiple comparisons, though, the 3-month effect was found to be nonsignificant.

“The study findings suggest that participants with moderate levels of distress about dying and death benefited most from CALM therapy in terms of reduction of such distress and improvement on the secondary outcomes of generalized anxiety, demoralization, spiritual well-being, and attachment security,” the researchers wrote. “Those with the lowest levels of death-related distress may be managing death-related concerns effectively and/or may be nonreflective about them; those with the highest levels may feel too overwhelmed to be able or willing to participate in conversations about such issues.”

Exactly how CALM exerts its effects on participants will be reported in a subsequent publication, Rodin and coauthors said. In addition, more research is needed to show which patients would benefit most from the CALM intervention, as well as the optimal timepoint for its administration.