Cancer Patients with Major Depressive Disorder: Testing a Biobehavioral/Cognitive Behavior Intervention.

Estimates for major depressive disorder (MDD) are 22%–29% for newly diagnosed cancer patients (Raison & Miller, 2003). Predictors of depression include cancer-specific traumatic stress (Palmer, Kagee, Coyne, & DeMichele, 2004), prior depressive episodes, and presence of comorbid anxiety disorders (e.g., Burgess et al., 2005). Depressive symptoms predict poorer quality of life (QoL; Golden-Kreutz & Andersen, 2004) and greater fatigue (e.g., Smith, Gomm, & Dickens, 2003) but are frequently undetected or underestimated by oncologists and nurses (McDonald et al., 1999). Unfortunately, there is no intervention designed specifically for cancer patients with MDD. Two recent trials (Ns ≤ 45) have adapted cognitive behavior therapy (CBT) to the context of cancer (Hopko et al., 2008; Savard et al., 2006) and have significantly reduced depressive symptoms. Other trials typically exclude clinically depressed patients, and those with MDD patients often had only modest benefit, if any (e.g., Weber et al., 2004). Lastly, psychosocial interventions for cancer patients have been found to be more effective in treating symptoms of anxiety rather than depression (i.e., Sheard & Maguire, 1999). In light of this problem, our aim was to design an intervention that would address the unique needs and challenges facing cancer patients with comorbid depression. The Biobehavioral Model of Cancer Stress and Disease Course (Andersen, Kiecolt-Glaser, & Glaser, 1994) postulates that cancer-specific stress interferes with adaptation to cancer. Data from the randomized clinical trial of the biobehavioral intervention (BBI) showed reduced risk of recurrence and death from breast cancer for intervention participants (Andersen et al., 2008) and gains for all secondary outcomes (e.g., distress, social support; Andersen et al., 2007, 2004; Thornton, Andersen, & Carson, 2008). Participants with clinically significant depressive symptoms (n = 45 of 227) who were randomized to BBI reported greater reductions in depressive symptoms compared with the Assessment Only arm (Thornton, Andersen, Schuler, & Carson, 2009). As we have discussed (Andersen, Golden-Kreutz, Emery, & Theil, 2009), some components of BBI are the same as those in used in cognitive therapy for depression (Beck, Rush, Shaw, & Emery, 1979). However, unlike BBI, CBT focuses efforts to reevaluate automatic thoughts, increase activity level (i.e., behavioral activation), and challenge core beliefs. Thus, the addition of CBT strategies not included in BBI would provide additional components needed for treating depression. Our treatment development strategy was to offer a tailored, combined BBI/CBT intervention specifically designed for cancer patients with MDD. This Phase II trial had three aims. First, we tested the effects of the BBI/CBT intervention in reducing depressive symptoms and remission of depression. Second, we explored the contribution of individual differences previously found to be important in cancer (i.e., traumatic stress) or depression trials (i.e., history of prior episodes, presence of a comorbid anxiety disorder). Third, we tested for intervention effects on secondary outcomes relevant to cancer patients: QoL, pain, and fatigue.