The effect of interpersonal psychotherapy on quality of life among breast cancer patients with common mental health disorder: a randomized control trial at Tikur Anbessa Specialized Hospital

Transdiagnostic psychological interventions for emotional disorders: A comprehensive meta-analysis

Previous meta-analyses have integrated evidence on the effects of transdiagnostic interventions for depression and anxiety symptoms. Nevertheless, no recent study covers all types of transdiagnostic interventions administered through a wide range of delivery formats, and targeting participants with different emotional disorders (i.e., mixed samples with different anxiety disorders or mixed depression/anxiety symptomatology). We used the most recent available searches (1st January 2024) of the Metapsy meta-analytic project of randomized trials on psychotherapy for depression and anxiety to identify studies comparing an intervention targeting at least two emotional disorders with a control group (waitlist, usual care, other non-active control). We conducted random-effects meta-analyses of 94 trials (108 comparisons between a psychotherapy and a control group) with 12,443 patients (who have at least a principal diagnosis of anxiety and/or unipolar depressive disorder, or a score above a cut-off point on an anxiety or depression validated self-report scale), to examine the effects on depression and anxiety symptomatology at post-treatment. The overall effect size of the pooled outcomes of depression and anxiety was g = 0.59 (95 % CI 0.50-0.68), with high heterogeneity (I2 = 78.88; 95 % CI 74.8-82.3) and a broad prediction interval (-0.18-1.37). The effects remained comparable after a series of sensitivity analyses, including multilevel analyses, exclusion of outliers, adjustment for risk of bias, and adjustment for publication bias. The results were also comparable for depression and anxiety symptoms when considered separately (effect sizes ranged from g = 0.54 to 0.61). However, when considering the impact on anxiety symptoms in studies focusing exclusively on participants with several anxiety disorders, the effects were somewhat larger (g = 0.87). A significantly higher risk of study dropout was found in the intervention conditions compared to the control groups. Transdiagnostic interventions are probably effective at post-treatment for adults with depression and/or anxiety.

Tailoring interpersonal psychotherapy to psycho-oncology patients (TIPTOP): feasibility study protocol

Objective

Patients with cancer suffering from comorbid symptoms of depression need a psychotherapeutic treatment that is specifically tailored to the exceptional context of acute or chronic cancer treatment. The conceptualization of depression in Interpersonal Psychotherapy (IPT) is a promising framework for symptoms of depression in patients with cancer, because it focuses on coping with stressful life events, managing change and accessing social support.

Method

The intervention was developed based on standard practice of group IPT for depression and adapted to the oncology setting by an expert panel. The IPT intervention comprises 10 weekly sessions of 60 minutes each. It is structured into modules incorporating IPT core themes: role transitions, grief, connection and interpersonal conflict. This feasibility study with an integrated qualitative study seeks to ascertain feasibility and acceptability of a larger trial of modified group IPT for adult patients with cancer within the context of a university clinics' outpatient treatment. In addition, the study will enable first evidence of the intervention's efficacy in reducing symptoms of depression and anxiety, and changes in interpersonal factors such as loneliness, thwarted sense of belonging, perceived burdensomeness, and perceived social support. Post-intervention semi-structured interviews will be recorded for qualitative content analysis.

Conclusion

Our findings will suggest whether investigating group IPT as proposed is an acceptable, feasible and safe approach to ameliorate symptoms of depression in patients with cancer. The study is innovative in that it provides a new treatment to patients of different cancer types and treatment stages, creating a setting that is naturalistic and realistic in the context of psycho-oncology services.

Non-Pharmacological Interventions for Managing the Symptoms of Depression in Women with Breast Cancer: A Literature Review of Clinical Trials

Symptoms of depression represent a significant burden to patients with breast cancer, not only because of the psychological stress associated with their diagnosis, but also because of the adverse effects of its treatment. We reviewed the clinical trials examining the management of the symptoms of depression in breast cancer patients through different non-pharmacological interventions in different databases (PubMed, Embase, Scopus, and the American Psychological Association). Cognitive behavioural therapy, interpersonal psychotherapy or psychodynamic psychotherapy, as well as acceptance and commitment therapy have been effective in improving symptoms of depression in cancer patients with moderate to severe symptoms. Physical exercise, yoga, mindfulness, and support groups have been shown to benefit patients with mild depressive symptoms. These interventions not only showed positive results in interventions in women with breast cancer in terms of the symptoms of depression, but also highlighted their benefits for comorbid anxiety, stress, and poor sleep quality; moreover, it is suggested that these interventions should be leveraged to manage mental health issues in breast cancer patients. The molecular effects of these interventions, such as the reduction in inflammatory cytokines and cortisol levels, have seldom been reported and need further studies.

The effectiveness of cognitive behavioral therapy in women with gynecological cancer: A systematic review and meta-analysis of randomized controlled trials

Objective

This study aimed to perform a meta-analysis of randomized control trials to evaluate the effects of cognitive behavioral therapy on depression, anxiety, fatigue, distress, the fear of cancer recurrence, and the quality of life in gynecological cancer patients.

Methods

An extensive literature search of PubMed, Web of Science, Scopus, and CINAHL was performed, and a meta-analysis was conducted on ten studies that included 1027 patients. The quality of the data was evaluated using the Cochrane Risk of Bias tool. The effect size of the mean difference and standardized mean difference were computed using Revman 5.4.1.

Results

Gynecological cancer patients receiving cognitive behavioral therapy showed decreases in depression (P < 0.001), anxiety (P = 0.01), fatigue (P < 0.001), distress (P = 0.03), and the fear of cancer recurrence (P = 0.01) compared to those receiving no treatment, whereas no improvement in quality of life was seen in the cognitive behavioral therapy group (P = 0.05).

Conclusions

Cognitive behavioral therapy was shown to be a useful treatment for the symptoms experienced by women with gynecological cancer, with significant effect sizes. However, more research is required to validate the efficacy of cognitive behavioral therapy in patients with gynecological cancer, considering the limitations of this study's small sample size and statistical heterogeneity.

Systematic review registration

PROSPERO- CRD42024516039.

Comparative efficacy of psychological interventions on anxiety and depression in patients with cancer: A systematic review and network meta-analysis

BACKGROUND

Numerous studies have demonstrated that psychological interventions are effective in alleviating anxiety and depression in patients with cancer. However, the optimal psychological intervention to alleviate anxiety and depression in patients with cancer remains unknown. This study was carried out to compare and rank the comparative effectiveness of various psychological interventions on anxiety and depression in patients with cancer.

METHODS

Databases, namely PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CNKI, WanFang, VIP and CBM were systematically searched from their inception dates to December 2023 for randomized controlled trials of psychological interventions for anxiety and depression in patients with cancer. Utilizing the Cochrane Review Manager 5.4, we evaluated the risk of bias in the studies included in the current study based on the Cochrane Handbook 5.1.0 Methodological Quality Evaluation Criteria. The NMA was conducted using STATA 15.0. This study did not involve human participants and therefore did not require ethical approval.

RESULTS

Thirty-one randomized controlled trials involving 3471 participants were included. MT [SMD = 1.35, 95% CI (0.76, 1.93)] and cognitive behavioral therapy (CBT) [SMD = 0.97, 95% CI (0.53, 1.42)] were superior to usual care in alleviating anxiety. Besides, interpersonal psychotherapy (IPT) [SMD = 1.17, 95% CI (0.06, 2.28)], CBT [SMD = 0.97, 95 % CI (0.63, 1.30)], and MT [SMD = 0.93, 95% CI (0.35, 1.50)] were superior to usual care in alleviating depression. In addition, CBT was superior to family therapy in alleviating depression [SMD = 0.73, 95% CI (0.08, 1.38)]. The MT, CBT, and IPT ranked in the top three in alleviating anxiety, while IPT, CBT, and MT ranked in the top three in alleviating depression.

CONCLUSION

MT and IPT would be a more appropriate option in alleviating anxiety and depression in patients with cancer, respectively. This study also suggested that CBT had a significant effect in alleviating negative emotions in patients with cancer. However, the results need to be validated by high-quality and large-sample studies.

Adaptations of interpersonal psychotherapy in psycho-oncology and its effects on distress, depression, and anxiety in patients with cancer: a systematic review

Objective

Patients with cancer experience significant psychosocial distress. Stressors include interpersonal difficulties like loneliness, isolation, thwarted belongingness, communication impediments, and conflicts. Interventions are required that address their specific psychosocial needs. Interpersonal Psychotherapy (IPT) is a promising concept for the treatment of psychosocial distress associated with cancer because it addresses patients' interactions and role transformations. This review aims to provide an overview of the current evidence regarding interventions for patients with cancer based on IPT.

Methods

A systematic review following PRISM guidelines was conducted, including randomized controlled trials of IPT-based interventions in patients with cancer, assessing effects on distress, depression, and anxiety.

Results

Eight studies were included, sampling 390 patients in total. Seven out of eight studies assessed exclusively women with breast cancer. Two studies described IPT interventions and showed stronger improvement in depression and anxiety compared to TAU and equal improvement in depression compared to other psychotherapy interventions. Six studies described remote Interpersonal Counselling (IPC). One found remote IPC to be superior to control conditions regarding depression, and one found remote IPC to be superior to attention control, but not active control conditions. No study found remote IPC to be superior to control conditions regarding distress.

Discussion

There are few randomized controlled trials of IPT for patients with cancer. Results regarding depression and anxiety are promising for in-person IPT, but mixed for remote IPC.

Conclusion

The review suggests in-person IPT, but not remote IPC, may yield benefits for patients with cancer. Research on the subject is scarce, and to inform implementation of IPT interventions, research with diverse groups of patients with cancer is required.

Systematic trial registration

PROSPERO, Identifier CRD42023410687.

Disruption of IDO signaling pathway alleviates chronic unpredictable mild stress-induced depression-like behaviors and tumor progression in mice with breast cancer

Women with breast cancer (BC) are often combined with psychological disorder such as depression and anxiety. Depression is associated or correlated with increased toxicity and severity of physical symptoms. However, the mechanism of BC progression related to the regulation of emotion-related circuitry remains to be further explored. The study aims to investigate indoleamine 2,3-dioxygenase (IDO) pathway mechanism underlying stress-induced progression of BC. BC cell line 4T1 was subcutaneously inoculated into BALB/c mice, and they then received daily chronic unpredictable mild stressors (CUMS) for 12 weeks. Depression-like behavior tests were conducted, including sucrose preference test (SPT), tail suspension test (TST), forced swimming test (FST), and novelty suppressed feeding test (NSF). The levels of 5-Hydroxytryptamine (5-HT) and inflammatory factors, IL-6, CXCL1, IL-10 and IL-4 were measured by enzyme linked immunosorbent assay (ELISA) of mouse serum. Immunohistochemical staining was performed to detect Ki67- or FOXP3-positive tumor cells. The status of IDO signaling pathway was assessed by immunoblotting analysis. CUMS induced depression-like behaviors, decreased the level of 5-HT, promoted tumor progression, enhanced the immunohistochemical staining of Ki-67, and promoted the activation of IDO signaling pathway in BC mice. The IDO signaling pathway was disrupted in mice by lentiviral transduction of shRAN-IDO. Lentivirus-mediated IDO knockdown attenuated CUMS-induced depression-like behaviors, increased the level of 5-HT, inhibited tumor progression, and reduced the immunohistochemical staining of Ki-67 in BC mice. The present study suggests that disruption of IDO signaling pathway alleviates CUMS-induced depression-like behaviors and inhibits tumor progression in BC mice.

Supportive care interventions for cancer patients in low- and middle-income countries (LMICs): a scoping review

PURPOSE

In high-income countries (HICs), supportive care is often used to assist cancer patients as they seek treatment and beyond. However, in low-and middle-income countries (LMICs), where more than 70% of all cancer-related deaths occur [1], the provision of supportive care has not been assessed. The purpose of this scoping review is to assess the type of supportive care interventions for cancer patients across the cancer care continuum in LMICs.

METHODS

We examined published articles reporting on supportive care interventions in LMICs. Following PRISMA guidelines, we performed a systematic search of PubMed, ERIC, CINAHL, and PsycINFO. We limited the scope to original research studies focused on LMICs, studies concerning any type of supportive care intervention for adult cancer patients, from diagnosis, treatment, and post-treatment.

RESULTS

Thirty-five studies met the criteria for inclusion in the scoping review. The majority were randomized clinical trials (RCT) or used a quasi-experimental design. The highest number of studies (n = 23) was implemented in the WHO Eastern-Mediterranean region, followed by South-East Asia (n = 6), Africa (n = 4), and Western-Pacific Regions (n = 2). Most studies focused on women's cancers and included interventions for psychosocial support, symptom management, health literacy/education, and patient navigation.

CONCLUSIONS

Although we found only a small number of interventions being conducted in these settings, our results suggest that providing different types of supportive services in less-resourced settings, even when health systems are fragmented and fragile, can improve mental health, physical health, and the quality of life (QoL) of cancer patients.