Williams, S., & Dale, J. (2006). The effectiveness of treatment for depression/depressive symptoms in adults with cancer: A systematic review. British Journal of Cancer, 94, 372–390.

To perform a systematic review of studies regarding the efficacy of psychotherapeutic and antidepressant interventions for cancer patients with depression or symptoms of depression

• Authors searched these databases: PubMed, CINAHL, Database of Abstracts and Reviews of Effects (DARE), Cochrane Database of Systematic Reviews (CDSR), Cochrane Controlled Trials Register (CCTR), PsycARTICLES, and manual searches of items from reference lists. Searched keywords consisted of multiple terms relevant to depression and cancer; the terms were from articles relevant to the review and U.S. National Library of Medicine medical subject headings (MeSH). Intervention terms included antidepressant agents, SSRI, fluoxetine, and cognitive therapy.
• Studies included related to randomized controlled trials (RCTs), reported in English, that involved pharmacologic and psychotherapeutic interventions for depression in adult patients with cancer.
• Excluded studies were those that used combined pharmacologic and psychotherapeutic interventions, complementary or alternative treatment for cancer, or informational or educational strategies.
   

The total number of references retrieved was 164. Authors conducted analysis according to the methodological-quality instrument developed Bo, Cho, and Bero.
 

The final number of included studies was 24. The sample range across studies of pharmacologic intervention was 892 (range = 40–549); of psychotherapeutic intervention, 2,518 (range = 36–450). Studies related to multiple disease sites.
 

• Authors analyzed reports of six pharmacologic trials, 18 psychotherapeutic interventions, and two studies of computer-based assessment and care planning. Most studies did not control for cointerventions. Most aimed at treatment of depression.
• The majority of psychotherapeutic trials involved use of cognitive behavioral therapy. Other interventions were social support, counseling, support and education, and psychotherapy.
• None of the trials using antidepressants reported avoidance or monitoring of cointerventions.
• One trial found paroxetine to be effective in cases of major depression. One found paroxetine to be effective in reducing symptoms of depression. 
• One trial reported that fluoxetine was ineffective in patients who presented with major depressive disorder. Response was not significantly higher than that of patients using placebo.
• Two trials were reported to show effectiveness in reducing symptoms of depression.
• Symptoms were measured at various time points with various instruments. 
• Of all studies analyzed, 42% demonstrated significant improvement in depression as measured.
   

Some evidence indicates that antidepressants are effective in reducing symptoms of depression in patients with cancer. Overall tolerability of antidepressants appeared to be good. Cognitive behavioral therapy was effective in reducing symptoms of depression. Another intervention that might be effective is the use of social support groups.

• Almost no trials monitored, avoided, or reported co-interventions that could affect symptoms of depression. 
• Most psychotherapeutic trials were single-center trials, a fact that limits generalizability.
• In many studies, recruited patients did not have significant psychological morbidity.
• Few pharmacologic studies reported tolerability data.
• The analysis included few studies of the use of antidepressants by the included patients.
• No studies described patients receiving palliative care.

Findings suggest that antidepressants, cognitive behavioral interventions, and support-group interventions can have a positive impact on symptoms of depression in patients with cancer. Variability in findings suggests that these interventions are likely to be of most benefit to patients who actually have clinically meaningful symptoms of depression. Further research regarding the efficacy of antidepressants in the included patients is needed. Studies should include data about co-interventions for depression.