Having reviewed the various systematic reviews and individual studies, the committee concludes that there is statistically significant, clinically relevant evidence to support the effectiveness of psychotherapeutic interventions in helping to manage anxiety or depression in adults with cancer—across disease sites, treatments, and types of interventions (e.g., psychoeducation, supportive therapies, cognitive therapies, relaxation techniques), and delivered to both individuals and groups. These findings apply despite the wide range of interventions, diversity of patients, and variety of study designs. The review of 60 studies by Jacobsen and colleagues (2006), examining only well-designed controlled studies with clinically relevant outcome data, found support for incorporating tested interventions into clinical practice guidelines. The National Cancer Control Initiative in Australia similarly found strong evidence for interventions that used cognitive-behavioral, supportive, and psychoeducational approaches for the management of depression and anxiety (National Breast Cancer Centre and National Cancer Control Initiative, 2003). Evidence with respect to three key types of psychotherapies is summarized below:
• Cognitive-behavioral therapy—This approach has been the most widely studied in randomized controlled trials and has been shown to help reduce psychological symptoms (anxiety and depression), as well as the physical symptoms of pain, nausea/vomiting, and fatigue, most effectively during the initial and treatment phases of illness. The approach involves teaching problem solving, reframing of thoughts, and ways of constructive coping, and often includes relaxation and guided imagery. The adjuvant therapy developed by Greer and colleagues is a well-studied model based on these principles (Greer et al., 1992; Moorey et al., 1994; Moynihan et al., 1998). Two studies (Nezu et al., 2003; Boesen et al., 2005) using cognitive-behavioral skill-based interventions found they were most beneficial for those who entered the trial with highest distress.
• Supportive psychotherapy—This approach involves providing emotional support and encouragement, focusing on emotional responses, and encouraging adaptive coping. Randomized trials have tested manualized supportive-expressive and supportive-existential psychotherapy for patients with early and advanced disease. All of these trials have shown efficacy in reducing distress, improving quality of life, and helping patients cope with the physical aspects of illness. Overall, there is strong evidence from clinical trials that these approaches yield benefits in reducing anxiety and depressive symptoms and improving well-being (Spiegel et al., 1981; Goodwin et al., 2001; Kissane et al., 2007). Another type of supportive psychotherapy—interpersonal psychotherapy—focuses on