Cognitive Rx Reduces Depression in Breast Ca Pts

AMELIA ISLAND, Florida—Individualized cognitive therapy (CT) is effective in reducing depression in women with metastatic breast cancer, Jose Savard, PhD, said at the American Psychosocial Oncology Society (APOS) Third Annual Conference (abstract II-2). Women with stage IV disease treated with CT had significantly lower depression scores after treatment, compared to untreated controls who remained on a waiting list to receive CT, reported Dr. Savard, associate professor of psychology, Laval University, Quebec, Canada.

"Cognitive therapy is an empirically supported treatment for depression in the general population, but its efficacy in the context of metastatic breast cancer has been assessed in just one study, which found that women assigned to group CT once a week for 8 weeks showed greater improvement in depression, total mood disturbance, and self-esteem than controls. However, these improvements were lost at the 3- and 6-month follow-up assessments," Dr. Savard said. For their study, Dr. Savard and her colleagues used individual CT, where patients met with their therapist on a one-to-one basis.

The study included 45 women with stage IV disease and a score of 7 or higher on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) or a score of 15 or higher on the Beck Depression Inventory (BDI). Other measures used were the Hamilton Depression Rating Scale (HDRS), the Insomnia Severity Index (ISI), and the Multidimensional Fatigue Inventory (MFI).

The women were randomized to immediate CT for eight weekly sessions, followed by three individual "booster" sessions at 3-week intervals thereafter (n = 25) or to a control group (n = 20) who were placed on the CT waiting list for 8 weeks and given CT at the end of that time. Each CT session lasted from 60 to 90 minutes, and strategies to treat depression in the general population were slightly adapted to meet the specific needs of women with metastatic cancer.

'Feasible and Effective'

The study's first analysis compared the CT patients after they received their treatment to the control patients after their waiting period but before they started CT, and found that the patients treated with CT had significantly lower HDRS scores, compared with untreated patients (P < .01). Pooled data from both groups after all had received CT showed equally good results, with significant reductions of HDRS, BDI, and HADS depression scores (all P values < .0001) and similar reductions of HADS anxiety, ISI, and MFI scores (all P values < .001). Moreover, these effects were well sustained at the 3- and 6-month follow-ups, Dr. Savard said.

"The fact that we used an individualized intervention as well as booster sessions after treatment termination may be the reason why we were successful in sustaining the treatment effects over time. Although this was a small sample, our results suggest that cognitive therapy in this population is feasible and very effective," she said.