Sertraline

To determine the impact of sertraline on executive function and quality of life in patients with advanced stage cancer and depression

At baseline, patients were evaluated for high levels of depressive symptoms. Patients with high levels were assigned to the intervention group. Patients in the intervention group were prescribed sertraline hydrochloride at 25–75 mg daily for 12 weeks. The dose of sertraline was evaluated two weeks after initiation and titrated to a therapeutic level as necessary. All patients were assessed at baseline prior to the initiation of sertraline in the intervention group and at 12 weeks. Participants were restricted from taking medications that might affect their cognitive functioning for greater than three days.

• N = 106
• MEAN AGE = 60.2 years (SD = 12.59 years)
• MALES: 53, FEMALES: 47
• KEY DISEASE CHARACTERISTICS: Stage 3 or 4 gastrointestinal, hematologic, or respiratory cancer; 86% received both chemotherapy and radiation therapy
• OTHER KEY SAMPLE CHARACTERISTICS: The mean educational level of the overall sample was 11.3 years (SD = 4.68 years). 

• SITE: Multi-site 
• SETTING TYPE: Multiple hospital settings
• LOCATION: First Affiliated Hospital of Zhejiang University, Zhejiang Hospital of Oncology, Shanxi Hospital of Oncology, China

Controlled trial with a pre- and post-trial design

• Wisconsin Card Sorting Test (WCST)
• Medical Outcomes Study Short Form survey (SF-36) 
• Hospital Anxiety and Depression Scale (HADS)
• Hamilton Anxiety Scale (HAM-A)
• Hamilton Depression Scale (HAM-D)

At baseline, patients with depressive symptoms had significantly higher scores indicating lower executive functioning than non-depressed patients on total errors, perseverative errors, nonperseverative errors, and categories achieved (p < 0.01), but not failure to maintain set as measured by the WCST. In addition, these patients had greater anxiety (p < 0.01) as measured by the HAM-A and poorer quality of life (p < 0.01) in all eight dimensions measured by the SF-36. At the 12-week follow-up, although patients in the intervention group had decreased HAM-D and HAM-A scores, scores were still significantly higher than in the control group (p < 0.05). In contrast, there were no longer any significant differences in executive functioning between groups. Similarly, because patients in the intervention group had improved scores on the SF-36 (p < 0.05), there were no longer any significant differences in quality of life between groups.

Sertraline may improve executive functioning and quality of life in patients with cancer. This improvement may be mediated by improvements in depressive symptoms.

• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition)  
• Measurement/methods not well described
• Findings not generalizable
• Subject withdrawals ≥ 10% 
• Other limitations/explanation: Although participants were restricted from taking medications for greater than three days that might impact their cognitive functioning, it is unclear whether the patients might have been under the influence of those medications during their evaluation. The duration of the intervention effect is unknown because of the lack of long-term (i.e., greater than months) follow-up assessments.

Sertraline may improve executive function and quality of life in patients with advanced stage cancer and depression. However, more research with larger sample sizes, randomized group assignments, and longer follow-up is warranted to determine whether the intervention is effective and sustainable.