CBT, Cancer and IAPT

a just published study of CBT for depression in patients with cancer has shown no effect [ Serfaty et al (2019)]. Patients were given CBT by IAPT staff in addition to treatment as usual (TAU) and the results compared with TAU alone. Whether the outcome measure was the PHQ9 or Beck Depression inventory there was no difference in outcome, see link below:

https://www.dropbox.com/s/iitvhyk5eyqjmyi/CBT%20for%20depression%20in%20cancer%202019.pdf?dl=0

The results suggest more generally, that if IAPT’s performance was compared to TAU no difference would be found. The study also casts doubt on the wisdom of IAPT’s sojourn into treating long term physical conditions.

Problems With Engagement

The intervention comprised up to 12 individual sessions (either face to face or over the phone), but the mean number of sessions received was 4.7 and over a third (35.6%) did not take up any sessions. They were all patients expected to live for 4 or more months. Interestingly 60% of patients had a previous history of depression. Of 2224 cancer patients only 10% (230) were found suitable and consented to treatment.

Some Methodological Issues

  1. There was no blind assessment of outcome using the standardised diagnostic interview (MINI) that was used to assess whether a patient was initially clinically depressed.
  2. TAU is a poor comparator as it does not control for the attention and expectations generated by being offered a special treatment (CBT). The appropriate comparator should have been an active placebo
  3. Therapists were rated using the Cognitive Therapy Rating Scale Revised but there is no mention as to whether this predicted outcome.

But CBT Can Make A Real Difference In The Right Hands

At The Right Time

One of the authors of the above study Kathryn Mannix, A Palliative Care Physician, has written a stunning book, With The End In Mind

With the End in Mind: How to Live and Die Well

Her capacity to be with people is truly amazing, this clearly is not just a job, for example her use of CBT with a patient with breathlessness as he awaits a lung transplant (he has cystic fibrosis) is truly exemplary. But she is a very credible source of persuasion with a detailed knowledge of the difficulties of those in Hospice care. I would wholeheartedly recommend you read this book.

Dr Mike Scott

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