Studies have reported up to 58% of cancer patients as having depressive symptoms and up to 38% as having major depression (Massie, 2004
). Depression may be particularly difficult to detect in patients suffering from cancer, especially those with terminal illness, and is difficult to distinguish from ‘appropriate sadness' related to cancer diagnosis, treatment and the approach of end of life (Lloyd-Williams, 2000
; Bailey et al, 2005
). There are also difficulties in deciding which somatic symptoms may be attributable to cancer and its consequences, and which may be due to depression (Lloyd-Williams, 2001
; Bailey et al, 2005
). Psychological distress, including adjustment problems, anxiety and depression, typically occurs at many points along the cancer trajectory, and may be exacerbated by physical pain, the effects of treatment, family difficulties, financial worries, etc. The importance of detecting and treating depressive illness in cancer patients lies not only in the relief of psychological distress and its impact on quality of life but also on consequent health service and societal costs. In addition, depression has been associated with increased impairment of immune response (Andersen et al, 1998
; Newport and Nemeroff, 1998
; Reiche et al, 2004
) and poorer survival (Buccheri, 1998
; Faller et al, 1999
; Watson et al, 1999
; Faller and Bulzebruck 2002
; Herjl et al, 2003
; Goodwin et al, 2004
Psychosocial needs are often inadequately addressed by cancer services, and depression is frequently unrecognised (Newport and Nemeroff, 1998
; Passik et al, 1998
; Petito and Evans, 1998
; Lloyd-Williams, 2000
; Sharpe et al, 2004
; Somerset et al, 2004
). Clinical practice guidelines for the psychosocial care of cancer patients are available in some countries, such as in the USA and Australia (Turner et al, 2005
). The National Institute for Clinical Evidence guidelines for the management of depression in primary and secondary care in the UK propose that screening for depression should be undertaken in primary-care and general hospital settings for high-risk groups, which include those with significant physical illnesses (NICE, 2004
There have been three recent systematic reviews (Barsevick et al, 2002
; Newell et al, 2002
; Uitterhoeve et al, 2004
) and two meta-analyses (Devine and Westlake, 1995
; Sheard and Maguire, 1999
) of psychotherapeutic interventions for patients with cancer and depression/depressive symptoms, the results of which provide broad support for such interventions. In their meta-analysis of 98 studies, Devine and Westlake (1995)
concluded that psychoeducational care is of benefit to adults with cancer and depression. Likewise, Barsevick et al's (2002)
systematic review of 36 studies concluded that psychoeducational interventions reduce depressive symptoms in patients with cancer, and that behaviour therapy or counselling alone or in combination with cancer education is beneficial. However, Sheard and Maguire (1999)
in their meta-analysis of 20 trials concluded that preventative psychological interventions in cancer patients do not have a clinical effect upon depression. Based on a systematic review of 15 randomised controlled trials, Newell et al (2002)
made tentative recommendations about the medium-term benefit of group therapy and the long-term benefits of education and structured counselling. Uitterhoeve et al's (2004)
systematic review of 13 trials concluded that psychosocial interventions had positive effects on patients with advanced cancer and depression.
In addition, a meta-analysis by Meyer and Mark (1995)
reported on the effects of psychosocial interventions with adult cancer patients in terms of emotional adjustment, which involved measures of such constructs as mood state, fear and anxiety, depression, denial or repression, self-esteem and distress. Although the study did not present findings on efficacy exclusively in terms of depression/depressive symptoms, it found that psychosocial interventions have positive effects on emotional adjustment. There were no significant differences found between types of interventions (behavioural interventions, nonbehavioural counselling and therapy, informational and educational methods, organised social support provided by other patients and other nonhospice interventions). Even so, the authors stated that it would be premature to conclude that there were no differences between treatment categories given the possible confounds.
However, none of these systematic reviews and meta-analyses distinguished between the presence of depressive symptoms and caseness for depression in cancer patients, so limiting their applicability to everyday clinical practice.
There have been no systematic reviews or meta-analyses to date published on the efficacy of antidepressant treatments for cancer patients with depression.
The aim of the following study, therefore, was to systematically review the efficacy of psychotherapeutic and antidepressant interventions for cancer patients with depression/depressive symptoms in terms of (i) reduction in depressive symptoms, (ii) reduction in caseness of clinical depression and (iii) adverse effects.