Hopko, D.R., Bell, J.L., Armento, M., Robertson, S., Mullane, C., Wolf, N., & Lejuez, C.W. (2008). Cognitive-behavior therapy for depressed cancer patients in a medical care setting. Behavior Therapy, 39,126–136.

To assess, in a medical care setting, the effectiveness of a brief cognitive behavioral treatment for depression on depressed patients with cancer

• Patients were screened for depression; researchers administered the Anxiety Disorders Interview Schedule-IV (ADIS-IV) to eligible participants and considered all self-report measures.
• Participants completed nine-week one-on-one cognitive behavior therapy for depression. Sessions were weekly. The same clinical graduate student assessed and treated all patients.
• Variables were examined pretreatment, post-treatment, and at three months after the therapy.

• The study reported on a sample of 13 patients (11 females, 2 males).
• Mean patient age was 52.2 years (SD = 10.9 years).
• Tumor-type distribution was breast (n = 7), lung (n = 1), stomach (n = 1), colon (n = 1), prostate (n = 1), pancreatic (n = 1), and bone cancer (n = 1); all had stage I or II cancer.
• All participants were Caucasian. The average length of education was 14.8 years.
• Mean level of major depression was 5.7 (SD = 1.1), suggesting moderate clinical depression.
• Average time since diagnosis was 1.5 years; three participants were actively on treatment. Coexistent diagnoses included generalized anxiety disorder (n = 7), social phobia (n = 3), panic disorder (n = 1), obsessive compulsive disorder (n = 1), specific phobia (n = 1), and anxiety disorder not specified (n = 1).
• Participants were included if not on antidepressants or antianxiety medications or if stabilized for eight weeks on consistent dose prior to study assessment.

• Single site
• Outpatient setting
• Cancer institute in Tennessee

Patients were undergoing the active treatment and transition phases of care.

A pre/post-test, convenience sample design was used.

• Harvard Department of Psychiatry National Depression Screening (HANDS) scale
• 10-item Anxiety Disorders Interview Schedule–IV (ADIS-IV)
• Hamilton Rating Scale for Depression (HRSD), a 24-item semistructured interview designed to measure symptom severity
• Beck Depression Inventory–II (BDI-II)
• Center for Epidemiological Studies of Depression Scale (CESD), a 20-item self-report questionnaire regarding symptoms of depression
• Beck Anxiety Inventory (BAI), a 21-item questionnaire designed to distinguish cognitive and somatic symptoms of anxiety
• Quality of Life Inventory (QOLI), a 16-item self-report measuring life satisfaction across a range of domains
• Medical Outcomes Study Short Form–36 (SF-36)
• Multidimensional Scale of Perceived Social Support, a 12-item scale that assesses adequacy of social support
• Client satisfaction questionnaire

• Patients completed an average of 118.9 (SD = 49.8) assigned activities, resulting in an overall patient adherence score of 82%. Post hoc analysis showed significant pre- and post-treatment improvement on measures of depression, anxiety, quality of life, and medical outcomes; improvements were clinically significant as indicated by moderate-to-large effect sizes (R = 0.6 to 2.0).
• All treatment gains were maintained at three-month follow-up. Somatic anxiety did increase slightly at follow-up.
• Patients were strongly satisfied with cognitive behavior therapy for depression.
• All patients improved significantly on the RCI, and all but one patient (92% of total) improved on the BDI and HRSD.
• 54% of patients demonstrated statistically significant improvement in somatic anxiety, according to the BAI, and 62% reported increased quality of life as measured by the QOLI.
• The SF-36 showed significant clinical change as follows: physical functioning (62%), mental health (62%), role emotional (54%), role physical (54%), general health (62%), bodily pain (54%), vitality (69%), and social functioning (62%).

Behavioral therapy interventions, especially when paired with cognitive techniques, may represent a practical medical care treatment to improve psychological outcomes for and quality of life of patients with cancer.

• The study had a small sample size, with less than 30 participants.
• The study lacked randomization, had no control group, included one site, and provided no assessment of anxiety symptoms and disorders and their relation to outcome.
• The study lacked multiple-baseline design.
• Longer-term follow-up is needed.
• A clinical graduate student was used instead of an experienced therapist.
• A comprehensive protocol was not used for the interview.

Depression is a major concern for patients with cancer. To identify patients who need treatment, tools should be developed that are more nurse-friendly and easier to administer.