The treatment of depression in cancer patients: a systematic review |
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Authors: | Gary Rodin Nancy Lloyd Mark Katz Esther Green Jean A Mackay Rebecca K S Wong Supportive Care Guidelines Group of Cancer Care Ontario Program in Evidence-based Care |
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Institution: | (1) Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, 610 University Avenue, Toronto, ON, M5G 2M9, Canada;(2) Southlake Regional Health Centre, 596 Davis Drive, Newmarket, ON, L3Y 2P9, Canada;(3) McMaster University/Cancer Care Ontario Program in Evidence-based Care, 1280 Main Street West, DTC, 3rd Floor, Hamilton, ON, L8S 4L8, Canada;(4) Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada;(5) Department of Radiation Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, ON, M5G 2M9, Canada |
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Abstract: | Goals of the work: To evaluate the efficacy of pharmacological and nonpharmacological treatments for depression in cancer populations.
Materials and methods: The Supportive Care Guidelines Group conducted a systematic review of the published literature through June 2005. Search sources
includes MEDLINE, EMBASE, CINAHL, PsycInfo, and the Cochrane Library. Comparative studies of treatments for depression in
cancer patients were selected for review by two group members based on predefined criteria.
Main results: Seven trials of pharmacological agents and four of nonpharmacological interventions were identified. Two trials detected a
significant reduction in depressive symptoms for mianserin compared with placebo, and one trial found alprazolam to be superior
to progressive muscle relaxation. Four drug trials found no significant difference between groups on depression measures although
posttreatment reduction of symptoms was observed for all groups in two trials comparing active treatments (fluoxetine vs desipramine
and paroxetine vs amitriptyline). Of the four trials involving nonpharmacological therapies for the management of depression,
two detected a benefit for treatment (a multicomponent nurse delivered intervention and an orientation program) over usual
care.
Conclusion: There is limited evidence for the effectiveness of pharmacological and psychosocial interventions in the treatment of cancer
patients with depressive disorders, and no evidence for the superiority of one treatment modality over another. Based on evidence
from the general population and other medically ill populations, combined approaches to the treatment of depression may be
the most effective. Further research is necessary in cancer patients to determine the relative effectiveness of psychosocial,
pharmacological, and combined treatments.
A paper presented as an invited lecture at the MASCC/ISOO 18th International Symposium of Supportive Care in Cancer in Toronto,
Canada, June 2006, was based in part on this review.
A complete list of Supportive Care Guidelines Group members is available at: . |
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Keywords: | Systematic review Depression Treatment Cancer |
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