Pitceathly, C., Maguire, P., Fletcher, I., Parle, M., Tomenson, B., & Creed, F. (2009). Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomised controlled trial. Annals of Oncology, 20, 928–934.

To determine if baseline intervention in persons free of depression and anxiety can prevent development of depression or anxiety at 6 and 12 months after diagnosis

Subjects were randomized to either the immediate-intervention or delayed-intervention groups. Intervention consisted of a 90-minute face-to-face interview followed by two telephone interviews (45 minutes each) at two weeks and six weeks after the initial interview. Therapeutic intervention included storytelling about initial experiences with diagnosis, exploration of thoughts about cancer-related events and concerns, and use of a booklet for examples of ineffective coping strategies.

• At 6 months, 355 patients were evaluated for the outcome variable; at 12 months, 313 patients were evaluated for the outcome variable.
• Mean patient age was 51.4 years; age range was 18.6–70.9 years.
• Female: 321; male: 144. There were 48 men in each of the three groups. (Assignment of women and men was randomized, final sample was not described.) 
• Participants:
  • Had various cancer diagnoses.
  • Were newly diagnosed with first episode of cancer.
  • Had a judged life expectancy of at least two years.

• Single site
• Outpatient
• Manchester, Greater Manchester, England

Active treatment

Randomized controlled trial

• A concerns checklist, a 14-item checklist to measure level of concern (0–5) regarding the physical, practical, relationship, or existential aspects of cancer and its treatment. A score of 8 or above indicated risk of developing depression.
• Structured Clinical Interview for DSM-IIIR (SCID), administered by trained interviewers at 6 and 12 months.
• Hospital Anxiety and Depression Scale (HADS).

• At the 6- or 12-month follow-up, 71 patients were diagnosed with an anxiety or depression disorder. At both follow-up evaluations, 13 were diagnosed with such a disorder.
• The six-month evaluation revealed no difference between anxiety or depression development in the immediate intervention group (14.3%) and the delayed intervention group (12.3%). Therefore, the two groups were evaluated as one group in the final analysis.
• Patients in the high-risk group who received the intervention showed odds of developing anxiety or depression that were lower than those of patients in the usual-care group (p = 0.05).

The therapeutic psychological intervention demonstrated the potential to prevent disorders relating to depression and anxiety in cancer patients at high risk for development of depression.

• The study did not include an appropriate control group.
• The study confirmed inter-rater reliability of the two therapists but presented no external confirmation of the proficiency with which each adhered to the protocol.
• A large proportion of the initial sample was lost to follow-up.
• Risks of bias were due to no attentional control and an unblended design.

In-person or by-telephone cognitive behavioral intervention delivered by nurses trained in intervention delivery could help to reduce the prevalence of depression and anxiety in newly diagnosed cancer patients. Initial determination of risk for development of clinical depression and anxiety can be useful to identify those patients who may benefit most from such an intervention.