Journal Article Annotations
2017, 3rd Quarter

Psycho-Oncology & Palliative Care

Annotations by Elie Isenberg-Grzeda, MD, and Carlos Fernandez-Robles, MD
October 2017

Efficacy and safety of celecoxib monotherapy for mild to moderate depression in patients with colorectal cancer: a randomized double-blind, placebo controlled trial
The impact of music therapy on anxiety in cancer patients undergoing simulation for radiation therapy

Also of interest:

Denlinger CS, Sanft T, Baker KS, et al: Survivorship, version 2.2017, NCCN clinical practice guidelines in oncology
J Natl Compr Canc Netw 2017; 15(9):1140-1163

These most recent NCCN clinical practice guidelines for survivorship highlight two areas of focus: menopausal symptoms and sexual dysfunction. The guidelines are a must-read for those working with a survivorship population, including psycho-oncologists. Many of the menopausal symptoms and sexual dysfunction symptoms can overlap with symptoms of mental illness, and psycho-oncologists may find themselves evaluating patients with many of these common cancer-related complaints. In addition, many of the treatments for cancer-related menopausal symptoms and sexual dysfunction are part of the psychopharmacologic toolbox, adding to the guidelines’ relevance for psychiatrists.

PUBLICATION #1 — Psycho-Oncology & Palliative Care

Efficacy and safety of celecoxib monotherapy for mild to moderate depression in patients with colorectal cancer: a randomized double-blind, placebo controlled trial

Alamdarsaravi M, Ghajar A, Noorbala AA, et al

Psychiatry Res 2017; 255:59-65

Cancer-related inflammation is an essential process in malignancies. Celecoxib, a nonsteroidal anti-inflammatory drug that acts via the selective inhibition of cyclooxygenase (COX)-2, has shown favorable effects in several psychiatric disorders. The present study aimed to assess the safety and efficacy of celecoxib single therapy on depressive symptoms of patients with colorectal cancer who underwent chemotherapy. The study was conducted as a 6-week, parallel-group, randomized, double-blind, placebo-controlled trial. Forty participants randomly received either 400mg/day celecoxib or placebo. Treatment effect was assessed using the Hamilton Depression Rating Scale (HDRS) and Visual Analogue Scale (VAS) score at baseline and at week 2, 4 and 6 of the trial. Over 6 weeks, patients who received celecoxib showed significant improvement in scores of the Hamilton Depression rating Scale (P=0.003). When comparing the Mean Difference (95% CI) between the two groups of therapy, the celecoxib group demonstrated greater reduction in HDRS score during the study period at weeks 4 (1.95, 95% CI 0.27-3.63, P value=0.024) and 6 (2.60, 95% CI 0.96-4.23, P=0.003). This study indicates celecoxib as a potential monotherapy treatment strategy for mild to moderate depression in patients with colorectal cancer who underwent chemotherapy.

On PubMed: Psychiatry Res 2017; 255:59-65

Annotation

The finding: Adult colorectal cancer patients who were receiving chemotherapy and who had mild to moderate depression (based on DSM diagnosis) were randomized to receive either celecoxib 200 mg twice daily (n=20) or placebo (n=20). The Hamilton Depression Rating Scale was used to measure depressive symptoms pre-intervention, and at 2-, 4-, and 6-weeks posttreatment. While both groups had improvement in HDRS scores over time, the celecoxib group had statistically significantly greater improvement in depressive symptoms compared to placebo. At each follow-up measurement, the celecoxib group had a statistically significantly greater percentage of full remitters compared to placebo.

Strength and weaknesses: The strength of this study is its randomized, double blind, placebo-controlled design. The weaknesses are the small sample size and short follow-up period.

Relevance: Leveraging our understanding of the association between depression and inflammation, a small number of studies have looked at using anti-inflammatory medications to treat depression. While there are conflicting data, this study adds to the small but growing literature on this topic. In addition, the fact that the patient population consisted of cancer patients who were receiving chemotherapy adds to its relevance since the evidence base for pharmacologic treatments of cancer-related depression is generally small. While this study had positive findings, the authors considered it a pilot study. If larger replication studies yield similar results, this will certainly add to the psycho-oncologist’s pharmacologic toolbox.

PUBLICATION #2 — Psycho-Oncology & Palliative Care

The impact of music therapy on anxiety in cancer patients undergoing simulation for radiation therapy

Rossetti A, Chadha M, Torres BN, et al

Int J Radiat Oncol Biol Phys 2017; 99(1):103-110

Purpose: Radiation therapy (RT) is associated with high stress levels. The role of music therapy (MT) for patients receiving RT is not well described. This study evaluates the impact of MT on anxiety and distress during simulation in patients with newly diagnosed head and neck or breast cancer.

Methods and Materials: This institutional review boardeapproved randomized trial of MT versus no MT at the time of simulation included the preeState-Trait Anxiety Inventory (STAI-S Anxiety) questionnaire and Symptom Distress Thermometer (SDT). Patients randomized to MT received a consultation with a music therapist, during which music of the patients’ choice to be played during simulation was selected. The no-MT patients did not receive the MT consultation, nor did they hear prerecorded music during simulation. Subsequent to the simulation, all patients repeated the STAI-S Anxiety questionnaire and the SDT.

Results: Of the 78 patients enrolled (39 in MT group and 39 in no-MT group), 38 had breast cancer and 40 had head and neck cancer. The male-female ratio was 27:51. The overall mean pre- and post-simulation STAI-S scores were 38.7 (range, 20-60) and 35.2 (range, 20-72), respectively. The overall mean pre- and post-simulation SDT scores were 3.2 (range, 0-10) and 2.5 (range, 0-10), respectively. The MT group had mean pre- and post-simulation STAI-S scores of 39.1 and 31.0, respectively (P<.0001), and the mean SDT scores before and after simulation were 3.2 and 1.7, respectively (P<.0001). The no-MT group’s mean pre- and post-simulation STAI-S scores were 38.3 and 39.5, respectively (PZ.46), and the mean SDT scores were 3 and 3.2, respectively (PZ.51).

Conclusions: MT significantly lowered patient anxiety and distress during the simula- tion procedure on the basis of the STAI-S questionnaire and SDT. Incorporating cultur- ally centered individualized MT may be an effective intervention to reduce stressors. Continued research defining the role of MT intervention in improving the patient experience by reducing anxiety is warranted.

On PubMed: Int J Radiat Oncol Biol Phys 2017; 99(1):103-110

Annotation

The finding: Patients undergoing radiation therapy simulation for breast or head & neck cancer were randomized to receive music therapy (n=39) or treatment as usual (n=39) prior to simulation. The authors measured pre- and postintervention anxiety and overall distress with the State and Trait Anxiety Inventory and the Distress Thermometer, respectively. They found statistically significant improvements in both anxiety and distress among patients who received music therapy, whereas the treatment as usual had no significant change in scores.Strength and weaknesses: The strengths of the study design included its use of a control group and use of validated tools to measure desired outcome variables. The main weaknesses included the lack of reporting sample size determination and the limited generalizability to patients with other cancer types or undergoing other cancer treatments. In addition, notable confounders (e.g., time allotment to treatment and control groups) were not measured.

Relevance: Radiation therapy can be associated with high rates of anxiety and distress, and in addition to its impact on patients’ overall wellbeing, can cause treatment disruption and burden on the healthcare system. While the authors did not examine the rates of treatment interruption or other systems-level outcomes, the impact on whole-person care and the novelty of this intervention make it noteworthy.