Managing Cancer and Living Meaningfully: An RCT of an Individual Psychotherapy for the Treatment of Depression in Patients with Metastatic Cancer.

Depression is a common expression of emotional distress in patients with advanced cancer, but is often undetected and untreated by medical caregivers. We have shown that it arises in response to multiple factors related to the disease, the individual, and the social context. Based on this research we have designed a psychological treatment to address the issues that contribute to depression in advanced cancer patients. This individual psychotherapy, called Managing Cancer and Living Meaningfully (CALM), has been tailored for patients with advanced disease. It consists of three to six individual sessions delivered over three months by specially trained social workers, with two booster sessions offered in the subsequent three months. CALM addresses issues related to: 1) symptom management and communication with health care providers; 2) changes in self and relations with close others; 3) spiritual well-being, or maintaining a sense of meaning and purpose; and 4) preparing for the future, sustaining hope and facing mortality. We will test the effectiveness of this intervention to relieve depression and promote psychological well-being in advanced cancer patients by comparing its effects to those achieved with group therapy and with usual care. If shown to be effective, CALM can be recommended for the treatment of depression in patients with advanced disease and shared with other centers.