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A randomized trial of interpersonal psychotherapy, problem solving therapy, and supportive therapy for major depressive disorder in women with breast cancer

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Abstract

Purpose

Breast cancer (BC) is a risk factor for major depressive disorder (MDD), yet little research has tested the efficacy of different psychotherapies for depressed women with BC. This study, the largest to date, compared outcomes of three evidence-based, 12-week therapies in treating major depressive disorder among women with breast cancer.

Methods

This randomized trial compared interpersonal psychotherapy (IPT), problem solving therapy (PST), and brief supportive psychotherapy (BSP). Conducted at the outpatient clinic of the New York State Psychiatric Institute/Columbia University, the trial offered bilingual treatment by treatment-specific psychotherapists supervised by treatment experts. The primary outcome was change in the Hamilton Depression Rating Scale (HAM-D) at 12 weeks. Secondary outcomes included other validated patient-reported outcomes for depression and quality of life.

Results

Of 179 women with breast cancer screening positive for depression at the Columbia Cancer Center, 134 eligible patients signed informed treatment consent. Half of patients were Hispanic and economically disadvantaged. Most women had stage I (35.2%) or II (36.9%) BC; 9% had stage IV. The three brief psychotherapies showed similar improvements on the HAM-D, with large pre-post effect sizes (d ~ 1.0); a priori defined response rates were 35% for IPT, 50% for PST and 31% for BSP, and remission rates 25%, 30% and 27%, respectively. The three treatments also showed similar improvements in the Quality of Life Enjoyment and Satisfaction Questionnaire. Dropout was high, ranging from 37 to 52% across treatments. Predictors of dropout included having < 16 years of education and annual family income < $20,000.

Conclusions

Among patients who completed treatment, all three psychotherapies were associated with similar, meaningful improvements in depression. Physical distance between the oncology and psychiatric treatment sites might have contributed to high dropout. This study suggests various psychotherapy approaches may benefit patients with breast cancer and major depression.

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References

  1. Van’t Spijker A, Trijsburg RW, Duivenvoorden HJ (1997) Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med 59:280–293

    Article  Google Scholar 

  2. Haque R, Shi J, Schottinger JE et al (2015) Tamoxifen and antidepressant drug interaction among a cohort of 16 887 breast cancer survivors. J Natl Cancer Inst 108:djv337

    Article  PubMed Central  CAS  Google Scholar 

  3. Bower JE, Ganz PA, Aziz N et al (2002) Fatigue and proinflammatory cytokine activity in breast cancer survivors. Psychosom Med 64:604–611

    Article  PubMed  Google Scholar 

  4. Haroon E, Raison CL, Miller AH (2012) Psychoneuroimmunology meets neuropsychopharmacology: translational implications of the impact of inflammation on behavior. Neuropsychopharmacology 37:137

    Article  PubMed  CAS  Google Scholar 

  5. Miller AH, Haroon E, Raison CL et al (2013) Cytokine targets in the brain: impact on neurotransmitters and neurocircuits. Depress Anxiety 30:297–306

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  6. Thompson DS, Shear MK (1998) Psychiatric disorders and gynecological oncology: a review of the literature. Gen Hosp Psychiatry 20:241–247

    Article  PubMed  CAS  Google Scholar 

  7. Okamo Y, Okamura H, Watanabe T et al (2001) Mental adjustment to first recurrence and correlated factors in patients with breast cancer. Breast Cancer Res Treatment 67:255–262

    Article  Google Scholar 

  8. Newport DJ, Nemeroff CB (1998) Assessment and treatment of depression in the cancer patient. J Psychosom Res 45:215–237

    Article  PubMed  CAS  Google Scholar 

  9. Fann JR, Thomas-Rich AM, Katon WJ et al (2008) Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp psychiatry 30:112–126

    Article  PubMed  Google Scholar 

  10. Massie MJ (2004) Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 2004:57–71

    Article  Google Scholar 

  11. Burgess C, Cornelius V, Love S et al (2005) Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 330:702–705

    Article  PubMed  PubMed Central  Google Scholar 

  12. Morris T, Greer HS, White P (1977) Psychological and social adjustment to mastectomy: a two-year follow-up study. Cancer 40:2381–2387

    Article  PubMed  CAS  Google Scholar 

  13. Meyer L, Aspergren K (1989) Long-term psychological sequelae of mastectomy and breast conserving treatment for breast cancer. Acta Oncol 28:13–18

    Article  PubMed  CAS  Google Scholar 

  14. Kissane DW, Clarke DM, Ikin J et al (1998) Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional survey. Med J Aust 169:192–196

    PubMed  CAS  Google Scholar 

  15. Blanco C, Olfson M, Goodwin RD et al (2008) Generalizability of clinical trial results for major depression to community samples: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 69:1276–1280

    Article  PubMed  Google Scholar 

  16. Rodin G, Lloyd N, Katz M et al (2007) Supportive care guidelines group of cancer care ontario program in evidence-based care. The treatment of depression in cancer patients: a systematic review. Support Care Cancer 14:802–817

    Google Scholar 

  17. Williams S, Dale J (2006) The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Br J Cancer 94:372–390

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Hopko DR, AM E, Robertson SM et al (2011) Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: randomized trial. J Consult Clin Psychol 79:834–849

    Article  PubMed  Google Scholar 

  19. <bib id="19>Nezu AM, Nezu CM, Felgoise SH et al (2003) Project Genesis: assessing the efficacy of problem-solving therapy for distressed adult cancer patients. J Consult Clin Psychol 71:1036

    Article  PubMed  Google Scholar 

  20. Markowitz JC, Kocsis JH, Fishman B et al (1998) Treatment of depressive symptoms in human immunodeficiency virus-positive patients. Arch Gen Psychiatry 55:452–457

    Article  PubMed  CAS  Google Scholar 

  21. Blanco C, Markowitz JC, Hershman DL et al (2014) A Pilot Study of Interpersonal Psychotherapy for Depressed Women with Breast Cancer. Am J Psychother 68:489–495

    Article  PubMed  Google Scholar 

  22. First MB, Gibbon M, Spitzer RL et al (1996) Structured clinical interview for DSM-IV axis I disorders-patient version (SCID-IP). New York State Psychiatric Institute, New York

    Google Scholar 

  23. Weissman MM, Markowitz JC, Klerman GL (2017) The guide to interpersonal psychotherapy, Oxford University Press, Oxford

    Book  Google Scholar 

  24. Schulberg HCSC, Madonia MJ, Imber SD (1993) Applications of interpersonal psychotherapy to depression in primary care practice. In: Klerman GL, Weissman MM (eds) New applications of interpersonal psychotherapy. American Psychiatric Pub, Washington, DC

    Google Scholar 

  25. Reynolds CF III, Frank E, Perel JM et al (1999) Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: a randomized controlled trial in patients older than 59 years. JAMA 281:39–45

    Article  PubMed  CAS  Google Scholar 

  26. Donnelly JM, Kornblith AB, Fleishman S et al (2000) A pilot study of interpersonal psychotherapy by telephone with cancer patients and their partners. Psycho Oncol 9:44–56

    Article  CAS  Google Scholar 

  27. Nezu AM, Wilkins VM, Nezu CM (2004) Social problem solving, stress, and negative affective conditions: social problem solving: theory, research, and training. American Psychological Association, Washington, DC, US, pp 49–65

    Book  Google Scholar 

  28. Sharpe M, Strong V, Allen K et al (2004) Management of major depression in outpatients attending a cancer centre: a preliminary evaluation of a multicomponent cancer nurse-delivered intervention. British J Cancer 90:310

    Article  CAS  Google Scholar 

  29. Dwight-Johnson M, Ell K, Lee P-J (2005) Can collaborative care address the needs of low-income Latinas with comorbid depression and cancer? Results from a randomized pilot study. Psychosomatics 46:224–232

    Article  PubMed  Google Scholar 

  30. Ell K, Xie B, Quon B et al (2008) Randomized controlled trial of collaborative care management of depression among low-income patients with cancer. J Clin Oncol 26:4488

    Article  PubMed  PubMed Central  Google Scholar 

  31. Terri L, Tanielian SC, Marcus AP, Suarez et al (2001) Datapoints: trends in psychiatric practice, 1988–1998: II. caseload and treatment characteristics. Psychiatr Serv 52:880–880

    Article  Google Scholar 

  32. Pinsker H (1997) A primer of supportive therapy. Analytic Press, Hillside

    Google Scholar 

  33. Novalis PN, Rojcewiez SJ, Peele R (1993) Clinical Manual of supportive psychotherapy. American Psychiatric Press, Washington, DC

    Google Scholar 

  34. Cuijpers P, Driessen E, Hollon SD et al (2012) The efficacy of non-directive supportive therapy for adult depression: a meta-analysis. Clin Psychol Rev 32:280–291

    Article  PubMed  Google Scholar 

  35. Markowitz JC, Kocsis JH, Christos P et al (2008) Pilot study of interpersonal psychotherapy versus supportive psychotherapy for dysthymic patients with secondary alcohol abuse or dependence. J Nerv Ment Dis 196:468–474

    Article  PubMed  Google Scholar 

  36. Barth J, Munder T, Gerger H et al (2013) Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Med 10:e1001454

    Article  PubMed  PubMed Central  Google Scholar 

  37. Evans DL, Charney DS, Lewis L et al (2005) Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry 58:175–189

    Article  PubMed  Google Scholar 

  38. Kissane DW, Grabsch B, Clarke DM et al (2007) Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial. Psycho Oncol 16:277–286

    Article  Google Scholar 

  39. McArdle JM, George WD, McArdle CS et al (1996) Psychological support for patients undergoing breast cancer surgery: a randomised study. Bmj 312:813–816

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  41. Guy W (1976) Clinical Global Impression Scale. The ECDEU Assess Man Psychopharmacol 338:218–222

    Google Scholar 

  42. Endicott J, Nee J, Harrison W et al (1993) Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacol Bull 29:321–326

    PubMed  CAS  Google Scholar 

  43. Robert R, Atkinson C, Mendias R (1984) Assessing the Client Satisfaction Questionnaire in English and Spanish. Hispanic J Behav Sci 6:385–395

    Article  Google Scholar 

  44. Oken MM, Creech RH, Tormey DC et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5:649–656

    Article  PubMed  CAS  Google Scholar 

  45. Frank E, Prien R, Jarrett R et al (1991) Conceptualization and rationale for consensus definitions of terms in major depressive disorder. Arch Gen Psychiatry 48:851–855

    Article  PubMed  CAS  Google Scholar 

  46. Montgomery SA (1994) Clinically relevant effect sizes in depression. Eur Neuropsychopharmacol 4:283–284

    Article  CAS  Google Scholar 

  47. Furukawa TA, Akechi T, Azuma H et al (2007) Evidence-based guidelines for interpretation of the Hamilton Rating Scale for Depression. J Clin Psychopharmacol 27:531–534

    Article  PubMed  Google Scholar 

  48. Rubio JM, Olfson M, Villegas L et al (2013) Quality of life following remission of mental disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 74:E445–E450

    Article  PubMed  Google Scholar 

  49. Hopko DR, Armento ME, Robertson SM et al (2011) Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: randomized trial. J Consult Clin Psychol 79:834–849

    Article  PubMed  Google Scholar 

  50. Markowitz JC, Kocsis JH, Bleiberg KL et al (2005) A comparative trial of psychotherapy and pharmacotherapy for “pure” dysthymic patients. J Affect Disord 89:167–175

    Article  PubMed  CAS  Google Scholar 

  51. Hellerstein DJ, Markowitz JC (2008) Developing supportive psychotherapy as evidence-based treatment. Am J Psychiatry 165:1355–1356

    Article  PubMed  Google Scholar 

  52. Kocsis JH, Gelenberg AJ, Rothbaum BO et al (2009) Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial. Arch Gen Psychiatry 66:1178–1188

    Article  PubMed  PubMed Central  Google Scholar 

  53. Markowitz JC, Patel SR, Balan IC et al (2009) Toward an adaptation of interpersonal psychotherapy for Hispanic patients with DSM-IV major depressive disorder. J Clin Psychiatry 70:214–222

    Article  PubMed  Google Scholar 

  54. Fortuna L, Alegría M, Gao S (2010) Retention in depression treatment among ethnic and racial minority groups in the United States. Depress Anxiety 27:485–494

    Article  PubMed  PubMed Central  Google Scholar 

  55. Lewis-Fernández R, Balan IC, Patel SR et al (2013) Impact of motivational pharmacotherapy on treatment retention among depressed Latinos. Psychiatry 76:210–222

    Article  PubMed  PubMed Central  Google Scholar 

  56. Sharpe M, Walker J, Hansen CH et al (2014) Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet 384:1099–1108

    Article  PubMed  Google Scholar 

  57. Walker J, Hansen CH, Martin P et al (2014) Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol 15:1168–1176

    Article  PubMed  Google Scholar 

  58. Applebaum AJ, Lichtenthal WG, Pessin HA et al (2012) Factors associated with attrition from a randomized controlled trial of meaning-centered group psychotherapy for patients with advanced cancer. Psycho Oncol 21:1195–1204

    Article  Google Scholar 

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Acknowledgements

Supported by NIH grant CA133050. Dr. Blanco work on this manuscript was part of his previous employment at the New York State Psychiatric Institute/Columbia University. The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations or agencies or the US government.

Funding

Supported by Grants supported by NIH Grant CA133050 (Drs. Blanco and Markowitz) and the New York State Psychiatric Institute (Drs. Chen, Hellerstein, Markowitz, Olfson and Wall). The Conquer Cancer Foundation / Breast Cancer Research Foundation (DLH). Dr. Blanco’s work on this project occurred as part of his previous employment with Columbia University. The sponsors had no additional role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. The views expressed in this manuscript are those of the authors and do necessarily represent those of the National Institute on Drug Abuse, the National Institutes of Health or the US Government. The authors declare they have no conflict of interest and no financial relationship with the funding organization.

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Authors and Affiliations

  1. Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, 20892, USA

    Carlos Blanco

  2. Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY, 10032, USA

    John C. Markowitz, David J. Hellerstein, Melanie Wall, Mark Olfson, Ying Chen, Jon Levenson, Cindy Varona & Mayumi Okuda

  3. Department of Psychology, Drexel University, Philadelphia, PA, 19104, USA

    Arthur M. Nezu

  4. Department of Hematology and Oncology, Palo Alto Medical Foundation, Sunnyvale, CA, 94086, USA

    Maika Onishi

  5. Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA

    Dawn L. Hershman

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  1. Carlos Blanco
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  12. Dawn L. Hershman
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Correspondence to Carlos Blanco.

Additional information

Trial registration: Clinicaltrials.gov: NCT00742573.

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Blanco, C., Markowitz, J.C., Hellerstein, D.J. et al. A randomized trial of interpersonal psychotherapy, problem solving therapy, and supportive therapy for major depressive disorder in women with breast cancer. Breast Cancer Res Treat 173, 353–364 (2019). https://doi.org/10.1007/s10549-018-4994-5

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  • DOI: https://doi.org/10.1007/s10549-018-4994-5

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