A brief psychological intervention called Managing Cancer and Living Meaningfully (CALM), specifically developed for people with advanced/metastatic cancer, reduced depressive symptoms and reduced the chances of developing depression compared with usual care, according to results of a randomized trial presented at the 2017 Annual Meeting of the Multinational Association of Supportive Care in Cancer.
At 3 and 6 months after CALM, patients who participated in the intervention had better preparation for end of life, greater opportunity to talk about future-oriented concerns and feel less frightened, and a greater ability to express and manage feelings.
In addition, patients in the CALM group reported that they were better able to discuss and feel understood about how cancer has affected their lives, better able to explore ways of communicating with the healthcare team and family, better able to deal with changes in the relationship wrought by cancer, and had greater clarification of their values and beliefs compared with patients in the usual care group.
“Systematic and routine psychological interventions for patients with advanced cancer are not implemented in most cancer centers, and there has not been evidence supporting the effectiveness of such interventions. CALM addresses practical and profound existential concerns facing people with advanced cancer. CALM is distinct from other interventions in that it is meant to help patients live with advanced cancer, rather than prepare them for the end of life,” explained lead author Gary Rodin, MD, Head of the Department of Supportive Care at the Princess Margaret Cancer Centre in Toronto, Canada.
CALM is a brief supportive-expressive talking therapy that provides 3 to 6 individualized 45- to 60-minute sessions delivered by a trained therapist over a period of 3 to 6 months. The intervention focuses on 4 domains that include symptom management and communication with healthcare professionals; changes in self and relationships with close others; spirituality and sense of meaning and purpose; and future-oriented concerns, hope, and mortality.
The study included 305 patients with advanced cancer randomized to CALM plus usual care or to usual care alone (controls). Primary caregivers were invited to attend 1 or more sessions. Both arms of the study were well balanced for demographic and disease characteristics. Median age was 59 years; about 60% were female, 84% Caucasian, and 71% with a committed partner.
At 3 months, 52% of patients in the CALM group had a clinically important reduction in severity of depressive symptoms compared with 33% of patients who received usual care. At 6 months, 64% of CALM patients versus 35% of controls had a clinically important reduction in depressive symptom severity.
CALM participants who were not depressed at baseline were less likely to become depressed at 3 months: 13% of the CALM group versus 30% of usual care patients had depressive symptoms at 3 months.
“We found that CALM is an effective intervention that alleviates depressive symptoms in individuals with advanced or metastatic cancer and helps them to address the multiple and predictable challenges that they face,” Dr Rodin said.
“This approach is generalizable. We are establishing a global network to train health professionals to deliver CALM and evaluate its effectiveness in diverse settings in more than 20 countries around the world,” Dr Rodin noted.