Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-24T17:02:48.009Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  27 September 2006

JOSÉE SAVARD ,
SÉBASTIEN SIMARD ,
ISABELLE GIGUÈRE ,
HANS IVERS ,
CHARLES M. MORIN ,
ELIZABETH MAUNSELL ,
PIERRE GAGNON ,
JEAN ROBERT  and
DANIÈLE MARCEAU
JOSÉE SAVARD
Affiliation:
Laval University Cancer Research Center, Université Laval, Québec, Québec, Canada School of Psychology, Université Laval, Québec, Québec, Canada
SÉBASTIEN SIMARD
Affiliation:
Laval University Cancer Research Center, Université Laval, Québec, Québec, Canada School of Psychology, Université Laval, Québec, Québec, Canada
ISABELLE GIGUÈRE
Affiliation:
Laval University Cancer Research Center, Université Laval, Québec, Québec, Canada
HANS IVERS
Affiliation:
Laval University Cancer Research Center, Université Laval, Québec, Québec, Canada School of Psychology, Université Laval, Québec, Québec, Canada
CHARLES M. MORIN
Affiliation:
School of Psychology, Université Laval, Québec, Québec, Canada
ELIZABETH MAUNSELL
Affiliation:
Population Health Research Unit, Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada Centre des maladies du sein Deschênes-Fabia, Hôpital du St-Sacrement, Québec, Québec, Canada
PIERRE GAGNON
Affiliation:
Faculty of Pharmacy, Université Laval, Québec, Québec, Canada Maison Michel-Sarrazin, Québec, Québec, Canada
JEAN ROBERT
Affiliation:
Centre des maladies du sein Deschênes-Fabia, Hôpital du St-Sacrement, Québec, Québec, Canada
DANIÈLE MARCEAU
Affiliation:
L'Hôtel-Dieu de Québec, Québec, Québec, Canada
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Cognitive therapyMetastatic breast cancerDepressionImmunity
Type
Research Article
Information
Palliative & Supportive Care , Volume 4 , Issue 3 , September 2006 , pp. 219 - 237
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aaronson, N.K., Ahmedzai, S., & Bergman, B. (1993). The EORTC QLQ-C30: A quality of life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365–376.Google Scholar
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.
Andersen, B.L., Farrar, W.B., Golden-Kreutz, D.M., et al. (2004). Psychological, behavioral, and immune changes after a psychological intervention: A clinical trial. Journal of Clinical Oncology, 22, 3570–3580.Google Scholar
Antoni, M.H., Lehman, J.M., Kilbourn, K.M., Boyers, A.E., Culver, J.L., Alferi, S.M., et al. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20(1), 20–32.Google Scholar
Bagby, R.M., Ryder, A.G., Schuller, D.R., et al. (2004). The Hamilton Depression Rating Scale: Has the gold standard become a lead weight? American Journal of Psychiatry, 161, 2163–2177.Google Scholar
Bastien, C.H., Vallières, A., & Morin, C.M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297–307.Google Scholar
Beck, A.T., Kovacs, M., & Weissman, A. (1979a). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47, 343–352.Google Scholar
Beck, A.T., Rush, A.J., Shaw, B.F., et al. (1979b). Cognitive Therapy of Depression. New York: The Guilford Press.
Beck, A.T., Ward, C.E., Mendelson, M., et al. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.Google Scholar
Bird, K.D. (2002). Confidence intervals for effect sizes in analysis of variance. Educational and Psychological Measurement, 62, 197–226.Google Scholar
Blackburn, I.M., Eunson, K.M., & Bishop, S. (1986). A two-year naturalistic follow-up of depressed patients treated with cognitive therapy, pharmacotherapy and combination of both. Journal of Affective Disorders, 10, 67–75.Google Scholar
Bourque, P. & Beaudette, D. (1982). Étude psychométrique du questionnaire de dépression de Beck auprès d'un échantillon d'étudiants universitaires francophones. Revue Canadienne des Sciences du Comportement, 14, 211–218.Google Scholar
Brugha, T., Bebbington, P., Tennant, C., et al. (1985). The List of Threatening Experiences: A subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine, 15, 189–194.Google Scholar
Chang, L., Gusewitch, G.A., Chritton, D.B.W., et al. (1993). Rapid flow cytometric assay for the assessment of natural killer cell activity. Journal of Immunological Methods, 166, 45–54.Google Scholar
Cohen, S. & Herbert, T.B. (1996). Health psychology: Psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annual Review of Psychology, 47, 113–142.Google Scholar
Cunningham, A.J., Edmonds, C.V.I., Jenkins, G.P., et al. (1998). A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer. Psycho-Oncology, 7, 508–517.Google Scholar
De Groote, D., Zangerle, P.F., Gevaert, Y., et al. (1992). Direct stimulation of cytokines (IL-1-B, TNF-a, IL-2, IFN-y and GM-CSF) in whole blood: Comparison with isolated PBMC stimulation. Cytokine, 4, 239–248.Google Scholar
DeRubeis, R.J. & Crits-Christoph, P. (1998). Empirically supported individual and group psychological treatments for adult mental disorders. Journal of Consulting and Clinical Psychology, 66, 37–52.Google Scholar
DeRubeis, R.J., Hollon, S.D., Amsterdam, J.D., et al. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409–416.Google Scholar
Edelman, S., Bell, D.R., & Kidman, A.D. (1999a). A group cognitive behaviour therapy programme with metastatic breast cancer patients. Psycho-Oncology, 8, 295–305.Google Scholar
Edelman, S., Lemon, J., Bell, D.R., et al. (1999b). Effects of group CBT on the survival time of patients with metastatic breast cancer. Psycho-Oncology, 8, 474–481.Google Scholar
Edgar, L., Rosberger, Z., & Nowlis, D. (1992). Coping with cancer during the first year after diagnosis. Cancer, 69, 817–828.Google Scholar
Edwards, B.C., Lambert, M.J., Moran, P.W., et al. (1984). A meta-analytic comparison of the Beck Depression Inventory and the Hamilton Rating Scale for Depression as measure of treatment outcome. British Journal of Clinical Psychology, 23, 93–99.Google Scholar
Evans, M.D., Hollon, S.D., DeRubeis, R.J., et al. (1992). Differential relapse following cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry, 49, 802–808.Google Scholar
Fava, G.A., Grandi, S., Zielezny, M., et al. (1994). Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. American Journal of Psychiatry, 151, 1295–1299.Google Scholar
Fawzy, F.I., Cousins, N., Fawzy, N.W., Kemeny, M.E., Elashoff, R., & Morton, D. (1990). A structured psychiatric intervention for cancer patients. I Changes over time in methods of coping and affective disturbance. Archives of General Psychiatry, 47, 720–725.Google Scholar
Fillion, L., Gelinas, C., Simard, S., et al. (2003). Validation evidence for the French Canadian adaptation of the Multidimensional Fatigue Inventory as a measure of cancer-related fatigue. Cancer Nursing, 26, 143–154.Google Scholar
Fillion, L., Kohn, P., Gagnon, P., et al. (2001). The Inventory of Recent Life Experiences for Cancer Patients (IRLE-C): A decontaminated measure of cancer-based hassles. Psychology and Health, 16, 443–459.Google Scholar
First, M.B., Spitzer, R.L., Gibbon, M., et al. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders–Patient Edition (SCID-I/P, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.
Frigon, J.-Y. & Laurencelle, L. (1993). Analysis of covariance: A proposed algorithm. Educational and Psychological Measurement, 53, 1–18.Google Scholar
Garssen, B. & Goodkin, K. (1999). On the role of immunological factors as mediators between psychosocial factors and cancer progression. Psychiatry Research, 85, 51–61.Google Scholar
Goodwin, P., Leszcz, M., Ennis, M., et al. (2001). The effect of group psychosocial support on survival in metastatic breast cancer. New England Journal of Medicine, 345, 1719–1726.Google Scholar
Goodwin, P.J. (2004). Support groups in breast cancer: When a negative result is positive. Journal of Clinical Oncology, 22, 4244–4246.Google Scholar
Greer, S., Moorey, S., Baruch, J.D.R., Watson, M., Robertson, B.M., Mason, A., et al. (1992). Adjuvant psychological therapy for patients with cancer: A prospective randomised trial. British Medical Journal, 304, 675–680.Google Scholar
Gruber, B.L. (1993). Immunological responses of breast cancer patients to behavioral interventions. Biofeedback and Self-Regulation, 18, 2–22.Google Scholar
Hamilton, M.A. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–61.Google Scholar
Herbert, T.B. & Cohen, S. (1993). Depression and immunity: A meta-analytic review. Psychological Bulletin, 113, 472–486.Google Scholar
Hollon, S.D., DeRubeis, R.J., Evans, M.D., et al. (1992). Cognitive therapy and pharmacotherapy for depression: Singly and in combination. Archives of General Psychiatry, 49, 774–781.Google Scholar
Hollon, S.D., DeRubeis, R.J., Shelton, R.C., et al. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62, 417–422.Google Scholar
Hotopf, M., Chidgey, J., Addington-Hall, J., et al. (2002). Depression in advanced disease: A systematic review. Part 1. Prevalence and case finding. Palliative Medicine, 16, 81–97.Google Scholar
Irwin, M. (1999). Immune correlates of depression. Advances in Experimental Medicine and Biology, 461, 1–24.Google Scholar
Jarrett, R.B., Basco, M.R., Risser, R., et al. (1998). Is there a role for continuation phase cognitive therapy for depressed outpatients? Journal of Consulting and Clinical Psychology, 66, 1036–1040.Google Scholar
Keselman, H.J., Algina, J., & Kowalchuk, R.K. (2001). The analysis of repeated measures designs: A review. British Journal of Mathematical and Statistical Psychology, 54, 1–20.Google Scholar
Kirchner, H., Kleinicke, C., & Digel, W. (1982). A whole-blood technique for testing production of human interferon by leukocytes. Journal of Immunological Methods, 48, 213–219.Google Scholar
Kline, R.B. (2004). Beyond Significance Testing: Reforming Data Analysis Methods in Behavioral Research. Washington, DC: American Psychological Association.
Kovacs, M., Rush, A., Beck, A.T., et al. (1981). Depressed outpatients treated with cognitive therapy or pharmacotherapy: A one-year follow-up. Archives of General Psychiatry, 38, 33–39.Google Scholar
Kroesen, B.-J., Mesander, G., ter Haar, J.G., et al. (1992). Direct visualisation and quantification of cellular cytotoxicity using two colour fluorescence. Journal of Immunological Methods, 156, 47–54.Google Scholar
Lambert, M.J., Hatch, D.R., Kingston, M.D., et al. (1986). Zung, Beck, and Hamilton Rating Scales as measures of treatment outcome: A meta-analytic comparison. Journal of Consulting and Clinical Psychology, 54, 54–59.Google Scholar
Lambert, M.J., Masters, K.S., & Astle, D. (1988). An effect-size comparison of the Beck, Zung, and Hamilton rating scales for depression: A three-week and twelve-week analysis. Psychological Reports, 63, 467–470.Google Scholar
Larson, M.R., Duberstein, P.R., Talbot, N.L., et al. (2000). A presurgical psychosocial intervention for breast cancer patients: Psychological distress and the immune response. Journal of Psychosomatic Research, 48, 187–194.Google Scholar
Lévesque, M., Savard, J., Simard, S., et al. (2004). Efficacy of cognitive therapy for depression among women with metastatic cancer: A single-case experimental study. Journal of Behavior Therapy and Experimental Psychiatry, 35, 287–305.Google Scholar
Marchioro, G., Azzarello, G., Checchin, F., Perale, M., Segati, R., Sampognaro, E., et al. (1996). The impact of a psychological intervention on quality of life in non-metastatic breast cancer. European Journal of Cancer, 32A(9), 1612–1615.Google Scholar
McGregor, B.A., Antoni, M.H., Boyers, A., et al. (2004). Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. Journal of Psychosomatic Research, 56, 1–8.Google Scholar
McLachlan, S.-A., Devins, G.M., & Goodwin, P.J. (1998). Validation of the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) as a measure of psychosocial function in breast cancer patients. European Journal of Cancer, 34, 510–517.Google Scholar
Moorey, S., Greer, S., Bliss, J., & Law, M. (1998). A comparison of adjuvant psychological therapy and supportive counselling in patients with cancer. PsychoOncology, 7, 218–228.Google Scholar
Morin, C.M. (1993). Insomnia: Psychological Assessment and Management. New York: The Guilford Press.
Murphy, G.E., Simons, A.D., Wetzel, R.D., et al. (1984). Cognitive therapy and pharmacotherapy: Singly and together in the treatment of depression. Archives of General Psychiatry, 41, 33–41.Google Scholar
Osoba, D., Aaronson, N., Zee, B., et al. (1997). Modification of the EORTC QLQ-C30 (version 2.0) based on content validity and reliability testing in large samples of patients with cancer. Quality of Life Research, 6, 103–108.Google Scholar
Papadopoulos, N.G., Dedoussis, G.V.Z., Spanakos, G., et al. (1994). An improved fluorescence assay for the determination of lymphocyte-mediated cytotoxicity using flow cytometry. Journal of Immunological Methods, 177, 101–111.Google Scholar
Reiche, E.M., Nunes, S.O., & Morimoto, H.K. (2004). Stress, depression, the immune system, and cancer. Lancet Oncology, 5, 617–625.Google Scholar
Robinson, J.P. (1993). Handbook of Flow Cytometry Method. New York: Wiley-Liss.
Rush, A.J., Hollon, S.D., Beck, A.T., et al. (1977). Comparative efficacy of cognitive therapy and imipramine in the treatment of depressed outpatients. Cognitive Therapy & Research, 1, 17–37.Google Scholar
SAS Institute. (2001). SAS/STAT User's guide, version 8: Volume 1, 2 & 3. Cary, NC: SAS Institute.
Savard, J., Laberge, B., Gauthier, J.G., et al. (1998). Evaluating anxiety and depression in HIV-infected patients. Journal of Personality Assessment, 71, 349–367.Google Scholar
Savard, J., Laberge, B., Gauthier, J.G., et al. (1999). Screening clinical depression in HIV-seropositive patients using the Hospital Anxiety and Depression Scale. AIDS and Behavior, 3, 167–175.Google Scholar
Savard, J., Laroche, L., Simard, S., et al. (2003). Chronic insomnia and immune functioning. Psychosomatic Medicine, 65, 211–221.Google Scholar
Savard, M.H., Savard, J., Simard, S., et al. (2005). Empirical validation of the Insomnia Severity Index in cancer patients. Psycho-Oncology, 14, 429–441.Google Scholar
Sayer, N.A., Sackeim, H.A., Moeller, J.R., et al. (1993). The relations between observer-rating and self-report of depressive symptomatology. Psychological Assessment, 5, 350–360.Google Scholar
Schedlowski, M., Tewes, U., & Schmoll, H.-J. (1994). The effects of psychological intervention on cortisol levels and leukocyte numbers in the peripheral blood of breast cancer patients. In The Psychoimmunology of Cancer: Mind and Body in the Fight for Survival? Lewis, C.E., O'Sullivan, C., & Barraclough, J. (eds.), pp. 336–348. Oxford: Oxford University Press.
Simons, A.D., Murphy, G.E., Levine, J.L., et al. (1986). Cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry, 43, 43–48.Google Scholar
Smets, E.M.A., Garssen, B., Bonke, B., et al. (1995). The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. Journal of Psychosomatic Research, 39, 315–325.Google Scholar
Smith, S. & Trinder, J. (2001). Detecting insomnia: Comparison of four self-report measures of sleep in a young adult population. Journal of Sleep Research, 10, 229–235.Google Scholar
Spiegel, D., Bloom, J.R., Kraemer, H.C., et al. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. The Lancet, 2, 888–891.Google Scholar
Sprangers, M.A.G., Groenvold, M., Arraras, J.I., et al. (1996). The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: First results from a three-country field study. Journal of Clinical Oncology, 14, 2756–2768.Google Scholar
Tabachnik, B.G. & Fidell, L.S. (2001). Using Multivariate Statistics (4th ed.). New York: Harper Collins Publishers.
Watson, M., Fenlon, D., McVey, G., & Fernandez-Marcos, M. (1996). A support group for breast cancer patients: Development of a cognitive-behavioral approach. Behavioural and Cognitive Psychotherapy, 24, 73–81.Google Scholar
Weisse, C.S. (1992). Depression and immunocompetence: A review of the literature. Psychological Bulletin, 111, 475–489.Google Scholar
Williams, J.B.W. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45, 742–747.Google Scholar
Wilson, K.G., Chochinov, H.M., De Faye, B.J., et al. (2000). Diagnosis and management of depression in palliative care. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 25–49. Oxford: Oxford University Press.
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.Google Scholar