Journal Article Annotations
2017, 3rd Quarter
Annotations by Elie Isenberg-Grzeda, MD, and Carlos Fernandez-Robles, MD
Also of interest:
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.
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.
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.