Beutel, M.E., Weissflog, G., Leuteritz, K., Wiltink, J., Haselbacher, A., Ruckes, C., . . . Brahler, E. (2014). Efficacy of short-term psychodynamic psychotherapy (STPP) with depressed breast cancer patients: Results of a randomized controlled multicenter trial. Annals of Oncology, 25(2), 378-384.

To determine the efficacy of short-term psychodynamic psychotherapy among women with breast cancer diagnosed with depression

Patients were randomized to study intervention or usual care groups. The usual care group received information about local counseling centers, and psychological diagnostic information was provided to their general practitioners. Physicians could refer for further treatment. Those in the experimental group received up to 5 pretreatment and 20 additional weekly psychotherapy sessions provided by psychotherapists who were trained in specific techniques for the study and a treatment manual. To ensure treatment fidelity, psychotherapists presented each patient in group supervision three times during the study. Study assessments were done at baseline, 6 months, and 12 months.

• N = 106  
• MEAN AGE = 51.8 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer; all had depression at baseline as determined by Structured Clinical Interview for DSM (SCID) and Hospital Anxiety and Depression Scale (HADS) score of at least 8.
• OTHER KEY SAMPLE CHARACTERISTICS: 55.8% were married, 32.7% had previous psychotherapy, and 56% were employed full-time or part-time.

• SITE: Multi-site
• SETTING TYPE: Outpatient 
• LOCATION: Germany

Randomized clinical trial

Remission at follow-up determined by SCID–I interview and HADS

By intention-to-treat (ITT) analysis (p = .007) and per protocol analysis (p = .02), remission rate was higher in the STPP group by HADs analysis. There was no difference in rates of remission by SCID criterion. Variables that were predictive of remission were study group, higher depression level at baseline, and time until post-treatment measure. STPP patients received an average of 18 sessions compared to an average of 2.4 sessions among controls. There was a trend for more use of antidepressant medication in the STPP group (p = .09).

Individual psychotherapy was shown to improve depression among depressed patients with breast cancer.

• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Key sample group differences that could influence results
• Subject withdrawals ≥ 10%
• Other limitations/explanation: Level of depression by HADs was higher at baseline in the experimental group. There was a > 30% drop-out rate.

Individual psychotherapy can be beneficial for patients with cancer experiencing clinical depression. Screening for depression can identify those patients who may benefit from interventions.