CanTalk: the clinical and cost effectiveness of CBT plus treatment as usual for the treatment of depression in advanced cancer; a randomised controlled trial
240 patients with advanced cancer and depression will receive either cognitive behavioural therapy alongside their usual care, or usual care alone, in a randomised trial to determine whether CBT improves their mental health and reduces healthcare costs. Depression affects up to a quarter of cancer patients, yet evidence for effective treatment in those with incurable disease is scarce. Untreated depression in advanced cancer is linked to earlier death, poorer quality of life for patients and carers, and longer hospital stays that drive up NHS costs. This trial directly addresses that gap by testing a widely available psychological therapy—CBT—in a population often excluded from mental health research. If CBT proves clinically and cost effective, the NHS could integrate it into routine oncology care through existing IAPT services. That would give patients with advanced cancer a practical, non-drug option for managing depression, potentially improving their remaining months and reducing strain on hospital resources. The study will also provide the first robust prevalence data for depression in this group, helping commissioners plan services.
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Title - CanTalk: the clinical and cost effectiveness of the addition of CBT to treatment as usual (TAU) for depression in advanced cancer: a randomised controlled trial. Background - Depression is one of the most prevalent mental disorders in patients with cancer (McDaniel 1995). It can affect the patient’s quality of life and that of their carers (Alexander 1993). It may also prolong hospitalisation and increase healthcare costs (Bowes and Boyle 2003). In those with advanced cancer untreated depression is associated with early death (Lloyd Williams et al). CBT is one of the most effective psychological interventions used to treat depression. Aim(s) - To conduct an RCT to determine the clinical and cost effectiveness of CBT plus TAU compared to TAU for depression in adults with cancer that is no longer amenable to curative treatment. Method(s) - 240 patients will be recruited from Oncology clinics and GP practices following screening to confirm a depression diagnosis. Patients will be randomised into 2 groups. Patients in the intervention group will receive up to 12 sessions of CBT by an IAPT therapist and those in the TAU group will receive their usual care. Results - Outcome measures will be used to assess patients at baseline, 6, 12, 18 and 24 weeks. They will include the PHQ-9, BDI-II, ECOG, EQ-5D, and CSRI which will record their healthcare encounters. Patients in the intervention arm will also provide a brief evaluation of CBT. Conclusion(s) - The study will identify the prevalence of depression in patients with advanced cancer and determine the clinical and cost effectiveness of CBT for the treatment of major depressive disorder.
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