CALM: A Depression Intervention for Cancer Patients at the End of Life

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After 3 months, patients in the CALM arm reported significantly less-severe depressive symptoms.
After 3 months, patients in the CALM arm reported significantly less-severe depressive symptoms.

The Managing Cancer and Living Meaningfully (CALM) intervention effectively relieves and prevents depression among patients with advanced cancer at the end of life compared with usual care, according to a study published in the Journal of Clinical Oncology.1

Evaluations of patients who underwent CALM — a supportive-expressive psychotherapeutic intervention — revealed improvements in depression, death anxiety, spiritual well-being, and attachment security, but findings were qualitative; quantitative results were previously not ready for analysis.

For this study, 305 patients with advanced cancer were randomly assigned to CALM or usual care. The Patient Health Questionnaire-9 (PHQ-9) was used to evenly distribute patients with moderate to severe depression between the treatment arms. Patients were assessed for depressive symptoms at baseline, 3 months, and 6 months. 

Depressive symptoms did not differ significantly at baseline, but after 3 months patients in the CALM arm reported significantly less-severe depressive symptoms compared with patients assigned to usual care (Δ = 1.09; P =.04), as well as after 6 months (Δ = 1.29; P =.02). 

Patients in the CALM arm were also more likely to have symptom remission to at least threshold severity, and were less likely to develop depressive symptoms of at least threshold severity. Further analyses also showed that patients assigned to CALM also had significantly improved end-of-life preparation at 6 months compared with usual care. 

The authors concluded that “additional research is needed to explore the optimal timing of CALM, the specific mechanisms of therapeutic action, the most appropriate and meaningful outcome measures, and feasibility and effectiveness of CALM in diverse cultural and clinical settings.”

Reference

Rodin G, Lo C, Rydall A, et al. Managing Cancer and Living Meaningfully (CALM): a randomized controlled trial of a psychological intervention for patients with advanced cancer[published online June 29, 2018]. J Clin Oncol. doi: 10.1200/JCO.2017.77.1097

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