Savard, J., Simard, S., Giguère, I., Ivers, H., Morin, C. M., Maunsell, E., . . . Marceau, D. (2006). Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: psychological and immunological effects. Palliat Support Care, 4, 219–237.

The study included eight (60- to 90-minute) weekly sessions of cognitive therapy (CT), followed by three booster sessions given at three-week intervals. The focus of therapy was aimed at developing an optimistic but realistic attitude toward their situation as opposed to a negative or overly positive attitude. 

Patients were randomly assigned either to the (1) CT group or the (2) waiting list control (WLC) condition.

Outcomes were depression, anxiety, insomnia, fatigue, quality of life (QOL), and immunological measures.

The sample was comprised of 45 Caucasian women with metastatic breast disease (stage IV) with depressive symptoms determined by Hospital Anxiety and Depression Scale–Depression (HADS-D) scores.

The study was conducted at three Canadian cancer clinics.

Patients were undergoing the active treatment phase of care.

The study was a two-group clinical trial with a WLC.

• Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)
• Scale for Suicide Ideation (SSI)
• HADS
• Beck Depression Inventory (BDI)
• Hamilton Depression Rating Scale (HDRS)
• Insomnia Severity Index (ISI)
• Multidimensional Fatigue Inventory (MFI)
• European Organization for Research and Treatment of Cancer QOL Questionnaire (EORTC QLQ-C33)
• EORTC Breast Cancer Specific QOL Questionnaire Module (EORTC QLQ-BR23)
• Health Behavior Questionnaire (HBQ)
• List of Life Events (LLE)
• Immunologic Measures included lymphocyte subpopulations, natural killer cell activity, and cytokine secretion.
   

Although the group comparison was statistically significant on the HDRS measure only, comparison of means of other measures (BDI and HADS-D) revealed a reduction in depression scores in the treatment group versus the control group. In pooled group analysis, these gains were sustained. Also, when using the pooled data set only, the authors found decreased anxiety, fatigue, and insomnia symptoms. No treatment effect was found on the immune variables.

The study supports the efficacy of using CT for treating depressive symptoms in women with metastatic breast cancer.
 

• The study had a small homogenous sample.
• Patients were not severely depressed, which left less room for improvement.
• A licensed psychologist trained in CT is required to deliver treatment.