CALM Therapy Helps Ease Depression in People Diagnosed With Advanced-Stage Cancer

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Depression is a common side effect of an advanced-stage cancer diagnosis. Still, because many people don’t want to talk about depression or other emotional distress, their doctors don’t know about the conditions and so can’t treat them.

A Canadian study suggests that a therapy program called CALM (Managing Cancer And Living Meaningfully) can help ease depression in people living with advanced-stage cancer.

The research was published online on June 29, 2018 by the Journal of Clinical Oncology. Read the abstract of “Managing Cancer and Living Meaningfully (CALM): A Randomized Controlled Trial of a Psychological Intervention for Patients With Advanced Cancer.”

The CALM program was developed by doctors at the Global Institute of Psychosocial, Palliative & End-of-Life Care (GIPPEC) at the Princess Margaret Cancer Centre in Toronto. The program consists of three to six one-on-one sessions over 3 months, with two booster sessions offered in the 3 months after the first sessions. Specially trained social workers lead the sessions, which are tailored to a person’s needs. CALM is designed to deal with issues related to:

  • symptom management and communication with doctors and other members of the healthcare team
  • changes in self and relations with other loved ones and close friends
  • spiritual well-being/maintaining a sense of meaning and purpose
  • preparing for the future, sustaining hope, and facing mortality

“We know there are a fairly predictable set of challenges that occur when people are diagnosed with a cancer that might only have a prognosis of 12 to 18 months,” said Gary Rodin, M.D., director of the GIPPEC and one of the people that developed CALM, in a taped interview at the 2017 American Society of Clinical Oncology Annual Meeting. “There are symptoms to manage, there are decisions they need to make about healthcare, there’s the impact on their self-concept, their identity, their relationships; there’s thinking about how they will spend their life and how to make their life meaningful when time is short and how to plan for the end. These are pretty big challenges. There is a lot of distress that often occurs and a lot of adjustment that is required. But we haven’t had a systematic approach to help patients and families deal with this. And that’s the rationale for CALM.”

The study included 305 people diagnosed with advanced-stage cancer; 182 of the participants were women and 26 of the women were diagnosed with metastatic breast cancer. Metastatic breast cancer is breast cancer that has spread to parts of the body away from the breast, such as the bones or liver.

The participants were randomly assigned to one of two programs:

  • the CALM program (151 people)
  • usual care, which consisted of routine distress screening and referral to psychosocial oncology care if the doctor thought it was necessary or the patient asked for it; fewer than 10% received any form of structured psychotherapy (154 people)

Sixty of the people in each group were women.

Before any type of therapy began, the researchers assessed the participants for depression, anxiety, spiritual well-being, quality of life, disheartenment, and ability to trust and rely on others in times of need using standardized questionnaires and tools. The same assessments were done 3 months and 6 months after the first therapy session.

There were no differences in any of the areas measured when the study started, except for antidepressant use:

  • 18% of the participants in the usual care group were taking an antidepressant
  • 10% of the participants in the CALM group were taking an antidepressant

When doing their analysis, the researchers accounted for this difference and found that it didn’t affect the findings.

The results showed that people in the CALM group reported depressive symptoms that were less severe compared to people in the usual care group 3 months after the study started. This difference continued at the 6-month assessment and seemed to be stronger.

Compared to people in the usual care group, people in the CALM group also:

  • were more prepared for the end of life
  • had less generalized anxiety
  • had greater spiritual well-being
  • had better ability to trust and rely on others

The researchers reported that people who had CALM therapy said the program “provides a ‘safe place’ that helped them to ‘be seen as a whole person by the medical system,’ ‘grow as a person,’ and ‘be able to handle death in a peaceful way.’”

While the CALM program is not available everywhere, the doctors who created it are working to build a network for CALM therapy by conducting training programs around the world, including Canada, China, Italy, Chile, Australia, and New Zealand.

If you’ve been diagnosed with metastatic breast cancer and are feeling depressed, anxious, frightened, and worried about your relationships with people close to you, it’s a good idea to talk to your doctor or another member of your healthcare team about these feelings. While your doctor may not be able to refer you to a CALM program, you can be referred to supportive psychosocial care.

For more information and support, visit the Breastcancer.org pages on Living With Metastatic Breast Cancer.

To connect with others affected by metastatic breast cancer, join the Breastcancer.org Discussion Board forum Stage IV and Metastatic Breast Cancer ONLY.


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