Comparative Effectiveness of Pharmacotherapy, Cognitive Behavioural Therapy and their Combination for Depression and...

Despite the recent rise in cancer prevalence in India, psychological support is largely ignored. There is very less research on effectiveness of cognitive behavioural therapy (CBT) and pharmacotherapy (PT) as treatment options for psychological distress in cancer patients in India. So, this study was planned to evaluate the relative efficacy of PT, CBT, and their combination in reducing anxiety and depressive symptoms in newly diagnosed cancer patients referred for psychiatric evaluation at a tertiary care hospital in India.

Between January 2022 and December 2024, newly diagnosed adult cancer patients referred for psychiatric evaluation were enrolled in the study. Of the 456 patients, 32 (6.9%) had a positive screening for generalised anxiety disorder and 75 (16.4%) for major depressive disorder. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition Disorders, Clinician Version was used to confirm the diagnosis for these patients. Patients selected (1) eight sessions of CBT, (2) selective serotonin reuptake inhibitors (SSRIs) (PT) or (3) both (combination therapy [COMB]). Depression and anxiety severity were assessed using the Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A), respectively. The minimal clinically important difference (MCID) was defined as a ≥3-point reduction in HAM-D and a ≥2-point reduction in HAM-A. A comparison of reductions in scale scores was made at baseline and at 6 weeks.

In the depression cohort (n = 75), for PT (n = 38), CBT (n = 19) and COMB (n = 18), mean HAM-D change was -2.8 ± 0.7 (standard error [SE] 0.12, 95% confidence interval [CI] [2.57, 3.03]), -0.8 ± 0.5 (SE 0.12, 95% CI [0.53, 1.01]) and -9.3 ± 8.9 (SE 2.10, 95% CI [5.14, 13.36]); baseline-adjusted Analysis of Covariance F(2,72) = 48.1, p < 0.001, partial h² = 0.57. COMB exceeded HAM-D MCID in every participant and achieved 33% remission. The mean change in HAM-A (n = 32) was -3.9 ± 1.9 (SE 0.56, 95% CI [2.79, 4.99]) (PT, n = 12), -3.8 ± 1.7 (SE 0.49, 95% CI [2.79, 4.71]) (CBT, n = 12) and -3.5 ± 1.4 (SE 0.50, 95% CI [2.52, 4.48]) (COMB, n = 8); the difference between the groups was not significant (F(2,29)=0.54, p = 0.59). All arms exceeded the HAM-A MCID threshold; however, response rates (≥50% reduction) remained ≤13%.

Combined PT (SSRI) and CBT showed the most significant improvement in depression symptoms, while all treatment approaches provided comparable relief for anxiety. The study underlines the importance of integrated care in oncology and advocates a combined approach to treating cancer patients with depression and anxiety. Further research is needed to optimise treatments for anxiety, particularly in settings with limited resources.