CALM Psychotherapeutic Intervention Reduces Depression in Patients With Advanced Cancer

Key Points

  • The CALM intervention reduced depressive symptoms vs usual care.
  • The CALM group was more likely to report remission of worse symptom scores and less likely to develop worse symptom scores.

In a study reported in the Journal of Clinical Oncology, Rodin et al found that a manualized psychotherapeutic intervention (Managing Cancer and Living Meaningfully, CALM) was successful in reducing depressive symptoms in patients with advanced cancer.

CALM is novel, brief, tailored supportive-expressive intervention for patients with advanced cancer and a prognosis of at least 1-year survival. As described by the authors, “On the basis of relational, attachment, and existential theory, CALM provides a therapeutic relationship and reflective space, with attention to the following domains: symptom management and communication with health-care providers, changes in self and relations with close others, spiritual well-being and the sense of meaning and purpose, and mortality and future-oriented concerns.”

Study Details

In the unblinded trial, 305 patients were recruited from outpatient oncology clinics at a comprehensive cancer center (Princess Margaret Cancer Centre) between February 2012 and March 2016 and randomized to an expected 3 to 6 CALM psychotherapy sessions plus usual care (n = 151) or usual care alone (n = 104). Randomization was stratified by Patient Health Questionnaire-9 (PHQ-9) depression score. Depressive symptoms were assessed at baseline, 3 months (primary endpoint), and 6 months (trial endpoint) in the intent-to-treat population. In the CALM group, 8 patients received 0 sessions, 26 received 1 or 2, 97 received 3 to 6, and 20 received 7 to 10.

Reduced Depressive Symptoms

The CALM group had reduced severity of depressive symptoms at 3 months (Cohen’s d = 0.23, P = .04), with the effect appearing to be increased at 6 months (Cohen’s d = 0.29, P = .02). Post hoc analyses using threshold depression severity of PHQ-9 ≥ 8 points, showed that the CALM group was more likely to report remission of symptoms of at least threshold severity at 6 months (odds ratio [OR] = 3.29, P = .005) and less likely to develop depressive symptoms of at least threshold severity at 3 months (OR = 0.36, P = .02). Among patients’ symptoms of at least threshold severity, those in the CALM group were more likely to report a clinically important PHQ-9 reduction of 5 points at 3 months (OR = 2.22, P = .04) and 6 months (OR = 3.22, P = .005).

The investigators concluded, “Findings suggest that CALM is an effective intervention that provides a systematic approach to alleviating depressive symptoms in patients with advanced cancer and addresses the predictable challenges these patients face.”

The study was supported by the Canadian Institutes of Health Research and through program funding from the Princess Margaret Cancer Centre, University Health Network.

Gary Rodin, MD, of the Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, is the corresponding author for the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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