Given, C., Given, B., Rahbar, M., Jean, S., McCorkle, R., & Cimprich, B. (2004). Does a symptom management intervention affect depression among cancer patients: Results from a clinical trial. Psycho-Oncology, 13, 818–830.

Patients underwent a focused assessment that corresponded with specific symptom management interventions. The interventions recommended were based on a cognitive behavioral approach. The control arm received usual care. Patients were assessed for symptoms such as nausea, vomiting, insomnia, dyspnea, anorexia, fever, cough, dry mouth, constipation, mouth sores, pain, and fatigue. Symptoms identified with depression—fatigue, insomnia, anorexia, and poor concentration—were placed in a subindex.

Of 609 eligible patients, 237 patients and their family caregivers participated in the study. Patients had been diagnosed with a solid tumor and were within two months of the first cycle of chemotherapy. Patients who were receiving radiation or who had had previous chemotherapy were ineligible. The study include men and women who had been diagnosed with a variety of tumor types in various cancer stages.

Randomized control trial

• The Center for Epidemiological Studies Depression Scale
• Two-sample t tests, a chi-square test, and a general linear model

Among those with higher levels of baseline symptoms except depression, cognitive behavioral interventions lowered depression at 10 weeks. In patients with a higher level of depression at baseline, the cognitive behavioral interventions were less effective.

Cognitive behavioral interventions may lower depression indirectly by managing symptoms that do not have a component that is primarily affective. Symptoms with a physiologic and psychological component may be more difficult to modify and require long-term intervention.

• Medications used to treat depression were not standardized. A variety of medications were used at various doses.
• The study did not detail how the intervention sessions were completed, only that researchers conducted telephone interviews and in-person sessions of 30–60 minutes.
• The study did not identify the background and training of the nurses who provided interventions.
• The study did not provide specific symptom management interventions. Knowing symptom-management strategies and specific guidelines would have been helpful.