Hart, S.L., Hoyt, M.A., Diefenbach, M., Anderson, D.R., Kilbourn, K.M., Craft, L.L., . . . Stanton, A.L. (2012). Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. Journal of the National Cancer Institute, 104, 990–1004.

To evaluate the effectiveness of psychotherapeutic and pharmacologic therapy, in depressed patients with cancer, by means of a meta-analysis and systematic review

• Researchers consulted the MEDLINE,^® CINAHL^®, EMBASE, PsycInfo, and Cochrane Collaboration databases. 7,700 references were retrieved.
• Vocabulary terms appropriate to each database were used and are available as a separate file online.
• Inclusion criteria consisted of the following characteristics: Patients were older than 17 years; had a cancer diagnosis at the time of the study; had symptoms of depression that had been measured; were randomized to study groups, to compare the intervention to any control condition; and had elevated symptoms of depression as defined by the authors.
• The study was excluded if eligibility did not include elevated symptoms of depression.

Researchers used the PEDro scale to evaluate study quality.

• 10 studies were included. One was eliminated from the meta-analysis because it was an outlier in the calculated effect size.
• 6 psychotherapy trials involved a total of 1,273 patients. 4 pharmacologic trials included 362 patients.
• Most participants were women, and their mean age was 51.

Multiple phases of care

Across all included trials, Hedges's g = 0.43 (95% CI, 0.48–1.54, p < 0.001) in favor of the intervention. Analysis of effect size at various follow-up periods showed that effect declined over time. Hedges's g effect size at 24 months poststudy entry was 0.19 and was not statistically significant. Follow-up at 18 months still showed a significant effect (g = 0.37, p < 0.001). Overall effect of pharmacologic interventions was g = 0.44 (p < 0.001); of cognitive behavioral therapy, g = 0.83 (p < 0.001); and of problem-solving therapy, g = 0.33 (p < 0.001).

For patients with cancer who had elevated symptoms of depression, psychotherapeutic and pharmacologic interventions were at least moderately effective in reducing symptoms of depression; however, efficacy may decline over time. Comparison of approaches showed that cognitive behavioral therapy had a substantially larger effect than did problem-solving therapy or medications.

Although the heterogeneity in analysis was not high, samples did vary substantially in terms of cancer stage, time elapsed since diagnosis, ethnicity, gender, and sample size.

Antidepressants, problem-solving therapy, and cognitive behavioral therapy were effective in reducing symptoms of depression in patients with cancer who had elevated symptoms of depression. Assessment of the symptoms of depression can identify patients who can benefit from these treatments. Since medication, problem-solving therapy, and cognitive behavioral therapy were efficacious, treatment selection should be based on each patient's characteristics and preferences. It appears that efficacy may diminish over time, pointing to the need for long-term follow-up and management of depression in patients such as those who met the research criteria.