Li, M., Kennedy, E.B., Byrne, N., Gerin-Lajoie, C., Katz, M.R., Keshavarz, H., . . . Green, E. (2016). Systematic review and meta-analysis of collaborative care interventions for depression in patients with cancer. Psycho-Oncology. Advance online publication. 

DOI Link

Purpose

STUDY PURPOSE: To provide an evidence-based review to update treatment guidelines for depression in patients with cancer. Conducted analysis of pharmacologic and collaborative care interventions

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: PsycINFO, MEDLINE, EMBASE, Cochrane Library, trial registries
 
INCLUSION CRITERIA: Randomized, controlled trials (RCTs); adult patients who met a threshold for depression on a rating scale or clinical interview
 
EXCLUSION CRITERIA: Nonrandomized, narrative reviews; case control studies; case studies; and editorials were excluded.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 2,276 systematic reviews and 1,682 RCTs
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Assessment of multiple systematic reviews (AMSTAR) tool and Cochrane Risk of bias assessment

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 25 RCTs, 2 pharmacologic, 9 psychologic, 7 collaborative care
  • TOTAL PATIENTS INCLUDED IN REVIEW = 3,502
  • SAMPLE RANGE ACROSS STUDIES: 38–472
  • KEY SAMPLE CHARACTERISTICS: Varied tumor types and multiple phases of care from active treatment to palliative care

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care
 
APPLICATIONS: Palliative care

Results

Collaborative care interventions showed a significant benefit for depression at 3 (SMD = –0.58, p = 0.0007), 6 (SMD = –0.53, p = 0.001) and 12 months (SMD = –0.49, p = 0.003). High heterogeneity existed among the studies. The pharmacologic intervention was analyzed among five studies that included a placebo control. The combined SMD favored the intervention (SMD = –0.58, p = 0.03). An analysis of the psychological intervention from six studies that included a control comparison showed no overall significant difference, although there were short-term post-treatment improvements that did not persist at follow-up assessments. Among studies that compared treatment groups to usual care or no treatment showed that experimental interventions were beneficial (SMD = –1.40, p = 0.01) in the short-term but did not persist at 6–12 months. Adverse events were seen only in the pharmacologic interventions.

Conclusions

All interventions examined had at least a short-term benefit for the treatment of depression. Pharmacologic interventions can be associated with adverse events, and psychological interventions had short-term efficacy but no long-term efficacy. Collaborative care interventions showed persistent benefit.

Limitations

  • Limited search
  • Limited number of studies included
  • High heterogeneity
  • Relatively few studies for each type of intervention analyzed

Nursing Implications

Pharmacologic, psychological, and collaborative care interventions demonstrated at least a short-term benefit for the treatment of depression among patients with cancer at various treatment phases. Collaborative care interventions showed strong and sustained effectiveness, suggesting that the integration of depression treatment into oncology settings can improve patient outcomes.

Legacy ID

6291