Brief Psych Intervention Reduced Distress Related to Advanced Cancer

CHICAGO-A brief psychological intervention-Managing Cancer and Living Meaningfully (CALM)-significantly reduced distress in patients with advanced cancer, according to the results of a study (abstract LBA10001) presented at the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 2–6.

At 3 months post-intervention, more than half of patients had a clinically significant reduction in depressive symptoms.

“CALM appears to be an effective intervention that alleviates distress in individuals with advanced or metastatic cancer and helps them to manage the profound and practical problems that they face,” said Gary Rodin, MD, head of the department of supportive care at the Princess Margaret Cancer Centre in Toronto.

According to Rodin, advanced cancer triggers enormous distress and brings challenges that can seem overwhelming. Despite that, “there hasn’t been a routine or systematic approach to help people with these problems,” Rodin noted.

Rodin and colleagues developed CALM as a novel, brief, manualized psychotherapeutic intervention designed to alleviate distress and facilitate adjustment in this patient population. In this study, 305 patients with advanced cancer were randomly assigned to usual care with or without CALM.

Patients assigned to CALM participated in 3 to 6 individual 45- to 60-minute sessions delivered by trained healthcare professionals over 3 to 6 months. CALM focused on symptom management and communication with healthcare providers; changes in self and relations with close others; sense of meaning and purpose; and the future and mortality. Family members and caregivers were invited to attend.

At baseline, 3 months, and 6 months, participants were assessed for depressive symptoms, death-related distress, and other secondary outcomes. The primary outcome was change in depressive symptoms.

Compared with usual care, patients assigned to CALM reported less severe depressive symptoms at 3 months, and the difference at 6 months was even greater. At 3 months, there was a clinically meaningful reduction in depressive symptoms in 52% of patients assigned to CALM compared with 33% assigned to usual care; at 6 months the reduction was 65% with CALM and 35% with usual care.

In addition, participation in CALM helped prevent depression in patients who did not have depressive symptoms at study entry. At 3 months, only 13% of patients who received CALM developed depressive symptoms compared with 30% of patients who received usual care.

According to Rodin, there is great generalizability to the CALM intervention. “We have trained people in more than 20 countries and are now in the process of establishing a global network to train health professionals in delivering CALM and evaluating its effectiveness and feasibility,” he said.

Commenting on the study, ASCO Expert Don S. Dizon, MD, FACP, said, “Just like we have embraced the concept that palliative care is important along the cancer care continuum, and particularly for patients living with disease that is not curable, these data add much more to the important concept of paying attention to patients’ symptoms beyond cancer-specific outcomes. We can do things to improve their quality of life. Patients facing advanced disease still need our help.”