***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The management of depression in patients with poor prognosis cancers , such as lung cancer , creates specific challenges . We aim ed to assess the efficacy of an integrated treatment programme for major depression  in patients with lung cancer compared with usual care . METHODS Symptom Management Research Trials ( SMaRT ) Oncology-3 is a parallel-group , multicentre , r and omised controlled trial . We enrolled patients with lung cancer and major depression from three cancer centres and their associated clinics in Scotl and , UK . Participants were r and omly assigned in a 1:1 ratio to the  depression care for people with lung cancer treatment programme or usual care by a data base software algorithm that used stratification ( by trial centre ) and minimisation ( by age , sex , and cancer type ) with allocation concealment . Depression care for people with lung cancer is a manualised , multicomponent collaborative care treatment that is systematic ally delivered by a team of cancer nurses and psychiatrists in collaboration with primary care physicians . Usual care is provided by primary care physicians . The primary outcome was depression severity ( on the Symptom Checklist Depression Scale [ SCL-20 ] , range 0 - 4 ) averaged over the patient 's time in the trial ( up to a maximum of 32 weeks ) . Trial statisticians and data collection staff were masked to treatment allocation , but patients and clinicians could not be masked to the allocations . Analyses were by intention to treat . This trial is registered with Current Controlled Trials , number IS RCT N75905964 . FINDINGS 142 participants were recruited between Jan 5 , 2009 , and Sept 9 , 2011 ; 68 were r and omly allocated to depression care for people with lung cancer and 74 to usual care . 43 ( 30 % ) of 142 patients had died by 32 weeks , all of which were cancer-related deaths . No intervention-related serious adverse events occurred . 131 ( 92 % ) of 142 patients provided outcome data ( 59 in the depression care for people with lung cancer group and 72 in the usual care group ) and were included in the intention-to-treat primary analysis . Average depression severity was significantly lower in patients allocated to depression care for people with lung cancer ( mean score on the SCL-20 1·24 [ SD 0·64 ] ) than in those allocated to usual care ( mean score 1·61 [ SD 0·58 ] ) ; difference -0·38 ( 95 % CI -0·58 to -0·18 ) ; st and ardised mean difference -0·62 ( 95 % CI -0·94 to -0·29 ) . Self-rated depression improvement , anxiety , quality of life , role functioning , perceived quality of care , and proportion of patients achieving a 12-week treatment response were also significantly better in the depression care for people with lung cancer group than in the usual care group . INTERPRETATION Our findings suggest that major depression can be treated effectively in patients with a poor prognosis cancer ; integrated depression care for people with lung cancer was substantially more efficacious than was usual care . Larger trials are now needed to estimate the effectiveness and cost-effectiveness of this care programme in this patient population , and further adaptation of the treatment will be necessary to address the unmet needs of patients with major depression and even shorter life expectancy . FUNDING Cancer Research UK and Chief Scientist Office of the Scottish Government In the context of chronic physical illness , such as breast cancer , depression is associated with increased morbidity , longer periods of hospitalization , and greater overall disability . Prompt diagnosis and effective treatment is , therefore , essential . Several small studies have established the efficacy of tricyclic antidepressants ( TCAs ) in this setting , and the selective serotonin reuptake inhibitors ( SSRIs ) would appear to be an alternative therapeutic option because of their established efficacy and better tolerability profile . This was a multicenter , double-blind , parallel-group study in which 179 women with breast cancer were r and omized to treatment with either the SSRI paroxetine ( 20–40mg/day ) , or the TCA , amitriptyline ( 75–150mg/day ) . After 8-weeks treatment , depressive symptomatology had improved markedly and to a similar extent in both groups on the Montgomery Asberg Depression Rating Scale . Clinical global impression ( CGI ) Global improvement and Patient global evaluation scales indicated that patients were minimally to much improved at study endpoint ; a change from moderately/mildly ill to borderline ill on the CGI severity of Illness scale . A steady improvement in quality of life was also observed in both groups . There were no clinical ly significant differences between the groups . In total , 47 ( 53.4 % ) patients in the paroxetine group and 53 ( 59.6 % ) patients in the amitriptyline group had adverse experiences , the most common of which were the well-recognized side-effects of the antidepressant medications or chemotherapy . Anticholinergic effects were almost twice as frequent in the amitriptyline group ( 19.1 % ) compared with paroxetine ( 11.4 % ) . This study has demonstrated that paroxetine is a suitable alternative to amitriptyline for the treatment of depression in patients with breast cancer Little has been done to study the effectiveness of antidepressants in controlling anxiety/depression in a population of cancer patients . A double‐blind placebo‐controlled study was therefore design ed to assess the effectiveness of 20 mg fluoxetine . Of 115 cancer patients who fulfilled entry criteria for levels of distress , 45 patients were r and omized to a  fluoxetine treatment group ( FA ) and 46 patients to a placebo group ( PA ) after a 1‐week placebo period design ed to exclude placebo responders . The Montgomery and Asberg Depression Scale ( MADRS ) , the Hamilton Anxiety Scale ( HAS ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Revised Symptom Checklist ( SCL90‐R ) and the Spitzer Quality of Life Index ( SQOLI ) were used to assess the efficacy of fluoxetine . The response rate , defined by a HADS score lower than 8 after 5 weeks of treatment , was not significantly higher in the FA group ( 11 % ) compared to the PA group ( 7 % ) . Compared to the PA group , patients in the FA group showed a significantly greater decrease in SCL90‐R mean total score after 5 weeks , but not a greater decrease in HADS mean score . No difference between the two groups was found in observer‐reported assessment s ( MADRS , HAS and SQOLI ) . Significantly more drop‐outs were observed in the FA group ( n=15 ) than in the PA group ( n=7 ) , although the frequencies of side‐effects were not significantly different BACKGROUND There is a lack of trials of psychodynamic treatments of depression in breast cancer patients . The purpose of this trial was to determine the efficacy of short-term psychodynamic psychotherapy ( STPP ) in non-metastatic breast cancer patients diagnosed with depression , one of the most frequent mental comorbidities of breast cancer . PATIENTS AND METHODS In a multicenter prospect i ve trial , 157 breast cancer patients with comorbid depression were r and omized to either individual STPP ( intervention group , N=78 ) or ' treatment as usual ' ( control group , TAU , N=79 ) . As our primary outcome measure , we hypothesized a higher rate of remission defined as no diagnosis of depression ( Structured Clinical Interview for DSM-IV ) and reduction in depression score by at least 2 points ( Hospital Anxiety and Depression Scale , HADS-D ) in STPP versus TAU at treatment termination . Secondary outcomes mainly refer to quality of life ( QoL ) . RESULTS In the intention to treat ( ITT ) analysis , 44 % of the STPP group achieved highly significantly more remission  than TAU ( 23 % ) . STPP treatment ( OR=7.64 ; P<0.001 ) was the strongest predictor for remission post-treatment ; time was also significant ( OR=0.96 ; P<0.05 ) . A high effect favoring STPP ( d=0.82 ) was observed for the HADS-D score post-treatment ( secondary outcome ) . Regarding further secondary outcomes ( QoL ) , analyses of covariance yielded main effects for group ( favoring STPP with an effect size of at least d=0.5 ) for global QoL , role , emotional and social functioning , pain , treatment side-effects , breast symptoms and upset by hair loss . CONCLUSIONS STPP is an effective treatment of a broad range of depressive conditions in breast cancer patients improving depression and functional QoL. Findings are limited by the drop-out rate ( ∼1/3 ) and delayed post-treatment assessment s. Future trials may consider stepped-care approaches , tailored to patients ' needs and requirements in the acute treatment phase OBJECTIVE Head and neck cancer ( HNC ) patients have a high incidence of cancer-related posttraumatic stress disorder ( PTSD ) and other anxiety and depressive disorders . We report the results from the first pilot r and omized controlled trial in which the efficacy of an early cognitive-behavioral therapy ( CBT ) program was compared with a non-directive supportive counseling ( SC ) intervention in reducing PTSD , general anxiety and depressive symptoms , and improving perceived quality of life in newly diagnosed , distressed HNC patients undergoing radiotherapy . PATIENTS AND METHODS Thirty-five HNC patients ( mean age=54.8 years ; 80 % males ) with elevated levels of PTSD , depression or anxiety were r and omized to seven individual sessions of a multi-modal CBT or non-directive SC , concurrent with patients ' radiotherapy . The SC intervention provided non-directive counseling support .  PTSD , anxiety and depressive symptoms ( primary outcomes ) , and cancer-related appraisal s and quality of life ( secondary outcomes ) were assessed pre-intervention ( baseline ) , 1 month , 6 months and 12 months post-intervention by diagnostic clinical interviews and vali date d self-report question naires . RESULTS The CBT and SC interventions were found to be equal in their effects in reducing PTSD and anxiety symptoms both in the short and longer term . However , up to 67 % of patients in the CBT program no longer met clinical or sub- clinical PTSD , anxiety and /or depression by 12 months post-treatment compared with 25 % of patients who received SC . CONCLUSION Findings indicate that the early provision of psychotherapy has utility in reducing PTSD , anxiety and depressive symptoms , and preventing chronic psychopathology in distressed HNC patients Background Depression is common among older cancer patients , but little is known about the optimal approach to caring for this population . This analysis evaluates the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment ( IMPACT ) program , a stepped care management program for depression in primary care patients who had an ICD-9 cancer diagnosis . Methods Two hundred fifteen cancer patients were identified from the 1,801 participants in the parent study . Subjects were 60 years or older with major depression ( 18 % ) , dysthymic disorder ( 33 % ) , or both ( 49 % ) , recruited from 18 primary care clinics belonging to 8 health-care organizations in 5 states . Patients were r and omly assigned to the IMPACT intervention ( n = 112 ) or usual care ( n = 103 ) . Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care provider and who offered education , care management , support of antidepressant management , and brief , structured psychosocial interventions including behavioral activation and problem-solving treatment . Results At 6 and 12 months , 55 % and 39 % of intervention patients had a 50 % or greater reduction in depressive symptoms ( SCL-20 ) from baseline compared to 34 % and 20 % of usual care participants ( P = 0.003 and P = 0.029 ) . Intervention patients also experienced greater remission rates ( P = 0.031 ) , more depression-free days ( P < 0.001 ) , less functional impairment ( P = 0.011 ) , and greater quality of life ( P = 0.039 ) at 12 months than usual care participants . Conclusions The IMPACT collaborative care program appears to be feasible and effective for depression among older cancer patients in diverse primary care setting Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer , but evidence to guide its management is scarce . We aim ed to assess the efficacy and cost of a nurse-delivered complex intervention that was design ed to treat major depressive disorder in patients who have cancer . METHODS We did a r and omised trial in a regional cancer centre in Scotl and , UK . 200 out patients who had cancer with a prognosis of greater than 6 months and major depressive disorder ( identified by screening ) were eligible and agreed to take part . Their mean age was 56.6 ( SD 11.9 ) years , and 141 ( 71 % ) were women . We r and omly assigned 99 of these participants to usual care , and 101 to usual care plus the intervention , with minimisation for sex , age , diagnosis , and extent of disease . The intervention was delivered by a cancer nurse at the centre over an average of seven sessions . The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale ( range 
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The recommendations and practical management tools were review ed as being well organized and helpful , although systemic barriers to implementation were identified .
This up date d guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and /or pharmacologic interventions , without evidence for the superiority of any specific treatment over another .