Manualised cognitive-behavioural therapy in treating depression in advanced cancer: the CanTalk RCT

Area of Science:

• Oncology
• Psychiatry
• Health Technology Assessment

Background:

• Depression affects up to 16.5% of individuals with advanced cancer, diminishing their quality of life.
• National Institute for Health and Care Excellence (NICE) guidelines suggest antidepressants and psychological therapies, like cognitive-behavioural therapy (CBT), for depression.
• The efficacy of CBT for advanced cancer patients with depression remains uncertain.

Purpose of the Study:

• To evaluate the clinical and cost-effectiveness of manualized CBT plus treatment as usual (TAU) versus TAU alone for advanced cancer patients with depression.
• To assess outcomes at multiple time points up to 24 weeks.

Main Methods:

• A parallel-group, single-blind, randomized trial involving 230 patients with advanced cancer and depression.
• Participants received either TAU with manualized CBT or TAU alone.
• Primary outcome measured by the Beck Depression Inventory (BDI-II) at 6, 12, 18, and 24 weeks.

Main Results:

• CBT did not demonstrate clinical effectiveness in reducing depression scores (BDI-II) compared to TAU.
• A significant positive effect of CBT was observed in the subgroup of patients who were widowed, divorced, or separated.
• Economic analysis indicated higher costs for CBT but no significant improvement in quality-adjusted life-years (QALYs).

Conclusions:

• Manualized CBT delivered through Improving Access to Psychological Therapy (IAPT) services offers no clinical benefit for advanced cancer patients with depression.
• CBT demonstrated effectiveness for widowed, divorced, or separated patients, aligning with findings from other studies.
• Further research into alternative treatments and the specific benefits of CBT in this subgroup is warranted.