Feasibility of the CanTalk study, a randomised controlled trial to test the clinical and cost effectiveness of CBT plus treatment as usual for the treatment of depression in advanced cancer


Year:

Session type:

Marc Serfaty1, Deborah Haworth1, Stephen Pilling3, Irwin Nazareth3, Louise Jones2, Michael King1,3
1Mental Health Sciences Unit,University College London, London, UK, 2Marie Curie Palliative Care Research Unit, Mental Health Sciences Unit, University College London, London, UK, 3PRIMENT Clinical Trials Unit University College London, London, UK

Background

The CanTalk trial is funded by UK National Institute of Health Research Health Technology Assessment programme in response to a NICE commissioned call. Cognitive Behavioural Therapy (CBT) is widely used in major depression but evidence of its efficacy for those with late-stage cancer is lacking. CanTalk investigates whether CBT, accessed through the UK NHS Improved Access to Psychological Therapies Service, is effective for depression in advanced cancer.

Method

A single-blinded randomised controlled trial (RCT), recruiting from several primary and secondary NHS sites across the UK. Adults with advanced cancer, prognosis greater than 4 months and screening positive for depression randomised to treatment as usual (TAU) or up to 12 sessions of CBT plus TAU. Follow-up every 6 weeks for 24 weeks assessing depression, QOL and economics. We report the feasibility phase, recruitment and retention rates in a sample of sites.

Results

Recruitment (n=56 to date) is challenged by clinicians identifying those in need, strict entry criteria, attrition through deterioration/death, governance of multi-centre set-up across primary and secondary care and shifting NHS reforms. Despite NIHR portfolio status, accrual requires intensive researcher time. Of those screened 15% are eligible for trial inclusion. We shall present updated data on recruitment and retention, including estimates of prevalence of depression in this population and acceptability of delivering CBT as disease progresses.

Conclusion

RCT's of supportive treatments in advanced cancer are needed to evidence best care and resource use. Successful accrual requires researcher time. Clinicians need support to identify those with advanced illness and approach them to participate in trials. Failure may result in inaccurate data on prevalence of depression and effectiveness of CBT.