Palliative & Supportive Care



Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: Psychological and immunological effects


JOSÉE  SAVARD  Ph.D. a1 a2 c1 , SÉBASTIEN  SIMARD  M.Ps. a1 a2 , ISABELLE  GIGUÈRE  M.Ps. a1 , HANS  IVERS  M.Ps. a1 a2 , CHARLES M.  MORIN  Ph.D. a2 , ELIZABETH  MAUNSELL  Ph.D. a3 a4 , PIERRE  GAGNON  M.D. a5 a6 , JEAN  ROBERT  M.D. a4 and DANIÈLE  MARCEAU  a7
a1 Laval University Cancer Research Center, Université Laval, Québec, Québec, Canada
a2 School of Psychology, Université Laval, Québec, Québec, Canada
a3 Population Health Research Unit, Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
a4 Centre des maladies du sein Deschênes-Fabia, Hôpital du St-Sacrement, Québec, Québec, Canada
a5 Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
a6 Maison Michel-Sarrazin, Québec, Québec, Canada
a7 L'Hôtel-Dieu de Québec, Québec, Québec, Canada

Article author query
savard j   [PubMed][Google Scholar] 
simard s   [PubMed][Google Scholar] 
giguere i   [PubMed][Google Scholar] 
ivers h   [PubMed][Google Scholar] 
morin cm   [PubMed][Google Scholar] 
maunsell e   [PubMed][Google Scholar] 
gagnon p   [PubMed][Google Scholar] 
robert j   [PubMed][Google Scholar] 
marceau d   [PubMed][Google Scholar] 

Abstract

Objective: Depression is particularly prevalent in patients with advanced cancer. Cognitive therapy (CT) is an empirically supported treatment for depression in the general population. However, efficacy remains to be demonstrated in patients with advanced cancer. A prior controlled trial of CT in a group format showed improvements in depression, mood disturbance, and self-esteem; however, these effects were not maintained over time. Studies examining the efficacy of individual format CT interventions that may ensure more long-term maintenance of benefits are necessary. This study assessed the efficacy of CT for depression administered individually in women with metastatic breast cancer and its effect on immune function.

Method: Forty-five women were randomly assigned to either individual CT or to a waiting-list control (WLC) condition. CT was composed of eight weekly sessions of CT and three booster sessions administered at 3-week intervals following the end of treatment.

Results: Patients treated with CT had significantly lower scores on the Hamilton Depression Rating Scale at posttreatment compared to untreated patients. Pooled data from both groups indicated significant reductions of depressive symptoms from pre- to posttreatment, as well as reduction of associated symptoms including anxiety, fatigue, and insomnia symptoms. These effects were well sustained at the 3- and 6-month follow-up evaluations. CT for depression did not appear to have a significant impact on immune functioning.

Significance of results: Findings of this study support the efficacy of CT for depression in this population and suggest that the administration of individual and booster sessions after treatment termination may be instrumental in sustaining the treatment effects over time.

(Received March 16 2006)
(Accepted May 13 2006)


Key Words: Cognitive therapy; Metastatic breast cancer; Depression; Immunity.

Correspondence:
c1 Corresponding author: Josée Savard, Ph.D., Laval University Cancer Research Center, 11 Côte du Palais, Québec, Québec, G1R 2J6, Canada. E-mail: josee.savard@psy.ulaval.ca