© Oncology Nursing Society. Unauthorized reproduction, in part or in whole, is strictly prohibited. For permission to photocopy, post online, reprint, adapt, or otherwise reuse any or all content from this article, e-mail pubpermissions@ons.org. To purchase high-quality reprints, email reprints@ons.org.


December 2014, Supplement to Volume 18, Number 6



Putting Evidence Into Practice: Evidence-Based Interventions for Depression

Caryl D. Fulcher, MSN, RN, PMHCNS-BC, Hee-Ju Kim, PhD, RN, OCN®, Patsy R. Smith, PhD, RN, and Tammie L. Sherner, MSN, APRN-CNS, BC


Depression is a distressing emotion that occurs during various times of the cancer trajectory. Depression often goes unrecognized and untreated, which can significantly affect cost, quality of life, and treatment adherence. The Oncology Nursing Society’s Putting Evidence Into Practice depression project team reviewed current literature to identify evidence-based interventions to reduce depression in people with cancer. Pharmacologic and nonpharmacologic interventions were evaluated, and opportunities for nurses to integrate recommendations into practice are offered in this article.


Depression often accompanies a cancer diagnosis and its treatment, occurring in as many as 52% of patients (Massie, Lloyd-Williams, Irving, & Miller, 2011). Differing definitions of depression, time of assessment, and measurement tools exist. Depressive disorders may be preexisting and chronic (dysthymia), episodic, or related to medical or even medication-induced conditions; however, the common feature is the presence of sad, empty, or irritable mood accompanied by somatic and cognitive changes that significantly affect functioning (American Psychiatric Association, 2013).


Depressive symptoms are sometimes difficult to distinguish in patients with cancer because treatment side effects, such as fatigue and sleep and appetite disturbances, may mimic depression. More telling are the psychological symptoms of hopelessness, worthlessness, guilt, loss of confidence, anxiety, irritability, and the inability to experience pleasure (Kleiboer et al., 2011; Miller & Massie, 2006), which are not effects of typical cancer treatment. In addition, not participating in medical care and withdrawing socially are markers of moderately severe depression; the inability to be cheered up or respond to good news or humor may mark more severe depression (Akechi, Ietsugu, et al., 2009). Different cancers also carry a higher prevalence of comorbid depression, with lung, breast, pancreatic, and oropharyngeal cancers rating highest (Massie, 2004; National Cancer Institute, 2013). Cancer-related risk factors include advanced disease, poorly managed pain, increased physical disability, and perceived lack of support (Miller & Massie, 2010; National Cancer Institute, 2013).


Depression affects quality of life and treatment adherence in significant ways. Patients who are depressed have difficulty making decisions and plans, avoid health-promoting activities, use community resources less, socially withdraw, and have difficulty tolerating treatment side effects (DiMatteo & Haskard-Zolnierek, 2011). Some studies attribute increased mortality to patients with coexisting depression (Satin, Linden, & Phillips, 2009). As a result, identification and management of depression is critical to compassionate and quality care.




This article reviews evidence retrieved from May 1, 2008, through December 31, 2013, and updates two previous publications (Fulcher & Badger, 2009; Fulcher, Badger, Gunter, Marrs, & Reese, 2008). English-language articles were searched for depression and therapy or systematic or neoplasms or oncology. A PubMed search provided 1,557 citations, and a CINAHL® search identified 461 citations. In addition, the National Comprehensive Cancer Network’s (2013) clinical guidelines for distress management were reviewed. Studies were included if they were full research reports, systematic reviews, guidelines, or meta-analysis; reported the measurement of depression and depressive symptoms; examined a depression intervention; and included patients with cancer. Based on the Oncology’s Nursing Society’s (Mitchell & Friese, n.d.) evidence evaluation criteria, each intervention is categorized (see Figure 1).


Levels of Evidence


Recommended for Practice


Antidepressant medications generally are effective in reducing depression in patients with physical illnesses (odds ratio [OR] = 2.33, p < 0.00001 for short-term response; OR = 2.13, p = 0.002 for long-term response) (Rayner et al., 2010). Two reviews also showed antidepressant benefit (Laoutidis & Mathiak, 2013; Walker et al., 2013). In other trials among patients with cancer, the effects of newer drugs were examined. A large-sample (N = 180) randomized, controlled trial showed a reduction in depression after patients used fluoxetine (Navari, Brenner, & Wilson, 2008). Small-sample, open-label, single-group trials reported positive effects of mirtazapine (Cankurtaran et al., 2008; Ersoy, Noyan, & Elbi, 2008), fluvoxamine (Suzuki et al., 2011), escitalopram (Park, Lee, Kim, Bae, & Hahm, 2012), paroxetine (Amodeo et al., 2011), duloxetine (Torta, Leombruni, Borio, & Castelli, 2011), and sertaline (Torta, Siri, & Caldera, 2008). Risk of developing depression was reduced in studies that examined the prophylactic use of citalopram (Lydiatt, Denman, McNeilly, Puumula, & Burke, 2008) or escitalopram (Lydiatt, Bessette, Schmid, Sayles, & Burke, 2013) in 23 and 148 patients with head and neck cancer, respectively. It is unknown if a specific antidepressant would be more appropriate for a cancer population or if antidepressants would be effective in patients in specific stages or cancer type.


Cognitive-behavioral interventions (CBIs) are designed to help patients identify negative or unhelpful thoughts, beliefs, and behaviors, establish goals to change them, and develop skills to implement helpful behaviors. CBIs can be provided in individual or group settings, in person, or via telephone. In two meta-analyses, CBIs showed moderate-to-strong statistical effects on depression (Hart et al., 2012; Naaman, Radwan, Fergusson, & Johnson, 2009). In a systematic review of seven CBI studies, short-term improvement was found in depressive symptoms in patients with prostate cancer (Chien, Liu, Chien, & Liu, 2014). However, findings from individual studies are mixed: Some reported positive effects (Brothers, Yang, Strunk, & Andersen, 2011; Given et al., 2004; Guo et al., 2013; Osborn, Demoncada, & Feuerstein, 2006; Qiu et al., 2013), whereas others reported no effect (Boesen et al., 2011; Fleming, Randell, Harvey, & Espie, 2014; Greer et al., 2012; Groarke, Curtis, & Kerin, 2013; Kangas, Milross, Taylor, & Bryant, 2012; Korstjens et al., 2011; Pitceathly et al., 2009; Serfaty, Wilkinson, Freeman, Mannix, & King, 2012). The format, frequency, and timing of the intervention program varied across studies. Content can also be diverse and often includes education or relaxation-training activities. That diversity may have contributed to inconsistent results across studies. Whether individual or group therapy is more beneficial for specific patient groups or whether the intervention has long-term effects is unclear (Naaman et al., 2009; Osborn et al., 2006).


Mindfulness-based stress reduction (MBSR) aims to teach people to more positively address experiences through present awareness of feelings, thoughts, and bodily sensations. MBSR techniques include body scans, simple yoga exercises, and meditation. Six to eight weeks of MBSR interventions are recommended to reduce depression, with sessions typically lasting two hours (Ando et al., 2009; Garland, Tamagawa, Todd, Speca, & Carlson, 2013; Hofmann, Sawyer, Witt, & Oh, 2012; Lengacher et al., 2012; Sharplin et al., 2010; Würtzen et al., 2013). A randomized, controlled trial of 336 patients with breast cancer showed positive effects in eight weekly group sessions at 6 and 12 months (Würtzen et al., 2013). A meta-analysis estimated a low-to-moderate significant effect size of 0.42 (Piet, Würtzen, & Zachariae, 2012). Most studies were conducted among patients with breast cancer, so the effects on male participants should be examined further.


 Psychoeducation or psychoeducational interventions cover a broad range of educational activities in combination with counseling and support. Education often includes information on treatments, symptoms, resources and services, training to provide care and respond to disease-related problems, and problem-solving strategies to cope with cancer. Interventions may be delivered individually or in groups, may be tailored or standardized, and may be provided online or via telephone.


Psychoeducational interventions consistently reduce depression, but effect size is small (Ashing & Rosales, 2013; Chien et al., 2014; Ell et al., 2011; Galway et al., 2012; Hopko et al., 2011; Ram, Narayanasamy, & Barua, 2013; Rottman et al., 2012; van der Meulen et al., 2013). Bruera et al. (2013) found psychoeducation plus placebo improved depression, as opposed to psychoeducation plus methylphenidate. Meta-analyses indicated psychoeducation may be more effective in early-stage disease and early phases of care (Galway et al., 2012; Zimmerman, Heinrichs, & Baucom, 2007). Badger et al. (2011) reported effects from telephone psychoeducation counseling and a support intervention of health education, but Komatsu et al. (2012) reported no differences among education, counseling, and support groups in a small sample with many limitations.


Studies using psychoeducational interventions tend to vary substantially in content, format, frequency, and intervention timing. An interpersonal relationship with the provider appears to be an important component in the intervention format, given that self-directed interventions of CD use were not effective (Ramachandra, Booth, Pieters, Vrotsou, & Huppert, 2009). Whether one type or length of an intervention is superior to others is unclear. Further study is indicated to determine standardized formats of intervention and delivery methods that are most effective and efficient.


Likely to Be Effective


Individual psychotherapy involves structured therapeutic interaction between a trained professional and a single client that addresses psychological challenges. A large randomized, controlled trial of patients with various cancers examined the effect of three-month individual psychotherapy sessions and reported that its effect was sustained at 12 months (Strong et al., 2008). In another randomized, controlled trial, individual psychotherapy significantly reduced anxiety and depression at the end of inpatient care and 12 months after discharge in a group of high-risk patients (Goerling, Foerg, Sander, Schramm, & Schlag, 2011). Of note, the intervention was not effective in a low-risk group (Goerling et al., 2011). Beutel et al. (2014) randomized women with breast cancer to usual care or short-term psychodynamic psychotherapy and found reduced depression in the intervention group. A meta-analysis suggested that depression in patients with advanced cancer can be effectively reduced with psychotherapy (Akechi, Okuyama, Onishi, Morita, & Furukawa, 2008). In their review, Naaman et al. (2009) noted effectiveness with psychotherapy treatment, but the overall effect size for individual intervention was –0.32 (95% confidence interval [–0.8, 0.15]) and was not significant. The reviews included several types of psychotherapy, various durations and timing of intervention, and significant heterogeneity in results. In addition, clinically diagnosed depression was not documented and study quality was not high.


Peer counseling is the support and guidance provided by a trained nonprofessional with a similar symptom or health-problem experience. A randomized, controlled trial with a small sample of patients with prostate cancer examined the effect of individual weekly peer support and reported that patients in the treatment group had significantly higher self-efficacy (p = 0.005) and lower depression (p = 0.032) at eight weeks (Weber et al., 2007). The study chose one-to-one peer counseling, believing men were unlikely to participate in support groups (Steginga, Pinnock, Gardner, Gardiner, & Dunn, 2005). Whether the outcomes of one-to-one peer support are the same as support groups is unclear.


Relaxation therapies usually incorporate breathing exercises and ways to relax the body that often involve diversion or visualization. A meta-analysis of 15 randomized, controlled trials reported that relaxation has small significant positive effects on emotional-adjustment variables such as depression, anxiety, and hostility (Luebbert, Dahme, & Hasenbring, 2001). However, most studies in the review were older (from years 1981–1995) and had low study quality. Nunes et al. (2007) found a decline in depression in a small randomized, controlled trial combining relaxation and visualization. In a randomized, controlled trial with a small sample, no effect of relaxation on depression was reported (Lutgendorf et al., 2010).


Exercise effectiveness on depression was reviewed in eight randomized, controlled trials and three meta-analyses. The studies were conducted over varying periods, involving supervised group exercise programs, home- or hospital-based exercise or walking programs, information sessions, and spa and aquatic programs. Most took place during curative treatment. No significant effects on depression were reported (Kwiatkowski et al., 2013; Saarto et al., 2012), and differences were not found between groups (Berglund et al., 2007; Cantarero-Villanueva et al., 2013; Payne, Held, Thorpe, & Shaw, 2008). A number of studies reported reduced depression with results ranging from small to significant (Brown et al., 2012; Carayol et al., 2013; Craft, Vaniterson, Helenowski, Rademaker, & Courney, 2012; Ergun, Eyigor, Karaca, Kisim, & Uslu, 2013; Hanna, Avila, Meteer, Nicholas, & Kaminsky, 2008; Mehnert et al., 2011; Midtgaard et al., 2005; Yang, Tsai, Huang, & Lin, 2010). Jacobsen et al. (2013) found exercise combined with stress management training yielded significant reduction in depression (p = 0.048) compared to usual care; supervised exercise and exercise offered in places conducive to interactions showed greater impact on depression (Craft et al., 2012). One review examined exercise in men on androgen-deprivation therapy and did not find sufficient evidence to determine its effect on depression (Chipperfield, Brooker, Fletcher, & Burney, 2013).


Effectiveness Not Established


Pharmacologic interventions include infliximab, a monoclonal antibody directed at inflammatory cytokines, and stimulants methylphenidate and modafinil. Gehring et al. (2012) reported that both stimulants showed improvement in depression, but findings are compounded by a small sample, different stimulants, dosing schedules, and the lack of a control group. Gong et al. (2014) found methylphenidate did not improve depression in two reviewed studies. In addition, infliximab did not improve depression (Raison et al., 2013).


Group psychotherapy was compared with a support group in patients with breast cancer (Bjorneklett et al., 2013; Vos, Visser, Garssen, Duivenvoorden, & de Haes, 2007), but no effect was found on depression. Herschbach et al. (2010) compared a cognitive-behavioral therapy group with a supportive experiential group in patients with cancer; neither intervention reduced depression. A systemic review suggested that group therapy appears to be superior to individual therapy in treating anxiety and depression; in addition, the study reported that patients with advanced breast cancer benefit more from long-term interventions that emphasize support (Naaman et al., 2009).


Online support groups were explored in two articles. Samples were small and neither had a control group. Griffiths, Calear, and Banfield (2009) attempted to determine effectiveness of Internet support groups on depression in a systematic review. Little data on depression could be found. Klemm (2012) compared moderated with peer-led, online support groups for women with breast cancer and found no significant difference in depressive symptoms between the two groups.


Supportive care or telephone support was studied in a randomized, controlled trial by White et al. (2012) and in weekly counseling providing information by Gotay et al. (2007); no benefits were found. Telephone support by case workers was compared to oncologists (Girgis, Breen, Stacey, & Lecathelinais, 2009); no significant intervention effect was found on anxiety or depression. Kroenke et al. (2010) reported improvement in depression severity using calls by nurse-physician teams; however, varying intervention times and disease stages limits the ability to generalize to other populations. Ashing and Rosales (2013) found that depressive symptoms decreased in Latina women receiving telephone sessions consisting of education and counseling for problem solving.


Acupuncture for six weeks was compared to usual care (Molassiotis et al., 2012); depression and fatigue were measured, but no baseline details were provided and no improvement was found in depression scores. Molassiotis et al. (2013) then compared self-needling with therapist-delivered acupuncture among women with breast cancer at a single site, but no improvement was found. Deng et al. (2013) compared sham (i.e., retractable needles that did not penetrate) with acupuncture in a randomized, controlled trial at a single site but found no effect on depression, fatigue, or anxiety. Feng et al. (2011) compared depression and sleep quality among 40 patients who received acupuncture and 40 who received fluoxetine 20 mg per day. Both groups demonstrated improved depression scores; however, the sample was small and no attentional control was included. Five of six randomized, controlled trials showered positive results in a systematic review (Garcia et al., 2013); however, studies had high risk of bias and were low quality.


Aromatherapy was studied by Yim, Ng, Tsang, and Leung (2009). They reviewed three studies involving depression among patients with cancer and found many inconsistencies in the aromatherapy interventions. Because aromatherapy is rarely used without massage, intervention effects are unclear.


Massage effect was studied on perceived stress, mood, depression, and cytokine concentrations in patients with breast cancer (Krohn et al., 2011). Reduced depression scores were significant (p < 0.005) in the treatment group; however, the sample size was small and other confounding factors limited the findings.


Healing touch, an energy therapy, was compared to massage and relaxation in two randomized, controlled trials. One incorporated three groups to evaluate the effect of healing touch, relaxation, and usual care on quality of life, fatigue, depressed mood, and immune measures (Lutgendorf et al., 2010). The group receiving healing touch showed improved depression scores, but the sample size was small despite a lengthy recruitment period. The second trial, a crossover study, was conducted using massage, healing touch, and caring presence to examine effect on mood and anxiety (Post White et al., 2003). No clear evidence reported that one treatment was more effective than another, but mood disturbance decreased in all study participants over time.


Meditation was studied in patients with breast cancer in two randomized, controlled trials (Kim, Kim, Ahn, Seo, & Kim, 2013; Milbury et al., 2013). No effect was found on depression one month postintervention.


Yoga was reviewed in two randomized, controlled trials with small samples and showed mixed changes in depressive symptoms (Bower et al., 2012; Dhruva et al., 2012). A pre- and poststudy of an urban Zen initiative, an optimal healing environment created with color, lighting, and holistic techniques, included 163 inpatients with cancer and reported no change in the intervention group (Kligler et al., 2011). A systematic review of 90 mind-body therapies, six involving yoga, resulted in a mix of positive, negative, and unequivocal changes (D’Silva, Poscablo, Habousha, Kogan, & Kligler, 2012). Mixed results were found in a systematic review of 18 randomized, controlled trials of patients with breast cancer (Harder, Parlour, & Jenkins, 2012). Three meta-analyses representing 32 studies found no effect of yoga on depression (Buffart et al., 2012; Sharma, Haider, & Knowlden, 2013; Zhang, Yang, Tian, & Wang, 2012). In addition, in their meta-analysis, Cramer, Lange, Klose, Paul, and Dobos (2012) found a short-term effect on depression that was not maintained at follow-up.


Music and art therapies may be helpful interventions for patients with cancer (Australian Government National Health and Medical Research Council, 2003). Music therapy (Bradt, Dileo, Grocke, & Magill, 2011; Zhou, Li, Yan, Dang, & Wang, 2011) and art therapies (Bar-Sela, Atid, Danos, Gabay, & Epelbaum, 2007; Thyme et al., 2009) produced mixed results. Results showed positive effects of reduced anxiety (Bradt et al., 2011) and reduced depression (Zhou et al., 2011); however, limitations, such as the variety of music interventions (Bradt et al., 2011) and unclear use of music (Zhou et al., 2011), restricted the establishment of effectiveness. Art therapies produced positive results for anxiety and depression after more than four to five therapy sessions (Bar-Sela et al., 2007; Thyme et al., 2009), but limitations included sample size, self-referral, lack of randomization, and no attentional control.


Qigong is an ancient Chinese practice that integrates physical posture, breathing techniques, and focused intention. Chen et al. (2012) reported that women with breast cancer receiving radiotherapy plus qigong demonstrated less depression over time than usual care (p = 0.05). Liu et al. (2008) found that intervention and control groups improved similarly on Beck depression inventories; however, both studies were small and lacked attentional control.


 Hypnosis was reviewed by Rajasekaran, Edmonds, and Higginson (2005). The poor quality of the studies (only one randomized, controlled trial) and heterogeneity of the study population limited evaluation.


Structured rehabilitation sessions were compared with usual care in an eight-week randomized, controlled trial of patients with breast cancer (Khan, Amatya, Pallant, Rajapaksa, & Brand, 2012) and in two 12-week multicomponent programs (Gagnon et al., 2013; Hanssens et al., 2011); improvement occurred in depression scores, but small samples and lack of a control group limited the establishment of effectiveness.


Structured assessment in the form of a 20-study systematic review found no data to support that screening for depression improves depression outcomes (Meijer et al., 2011). A large randomized, controlled trial reported improved depression scores with depression screening versus routine care (McMillan, Small, & Haley, 2011).


Early palliative care showed mixed results. Pirl et al. (2012) found patients with depression at baseline showed reduced scores with proactive palliative care team involvement; however, Kao, Hu, Chiu, and Chen (2014) found no effect on depression in a small study.


Tai chi in twice-weekly sessions showed depression declined in a small sample (Galantino, Callens, Cardena, Piela, & Mao, 2013).


Tailored information in packages of pamphlets, computer information, and DVDs showed depression decline in a single, nonrandomized study (D’Souza, Blouin, Zeitouni, Muller, & Allison, 2012).


Other interventions were represented by only one study with a small sample and showed no significant impact. They included narrative interviewing, an intervention in which patients were encouraged to discuss meaning, suffering, and well-being (Lloyd-Williams, Cobb, O’Connor, Dunn, & Shiels, 2012); the medical herb guarana (da Costa Miranda et al., 2009); and Reiki, a spiritual practice of hands-on healing (Potter, 2007). One study of computer games using virtual reality in pediatric patients showed improvement in depression scores, but sample bias and generalizability are limiting factors (Li, Chung, & Ho, 2011).


Effectiveness Unlikely


Quintard and Lakdja (2008) examined the effect of various beauty treatments (e.g., manicures, pedicures, makeup sessions, depilation, hairdressing, massages) provided by professionals in a randomized, controlled trial with 100 female patients with cancer. They found no differences in depression and anxiety between the intervention and control groups.


Expressive writing or emotional disclosure found a beneficial effect on psychological well-being in a meta-analysis in primarily healthy participants (Frattaroli, 2006). However, no study supports its benefit on depression in patients with health problems. A large randomized, controlled trial (Jensen-Johansen et al., 2012) and a multisite randomized, controlled trial (Low, Stanton, Bower, & Gyllenhammer, 2010) examined the effect of 20-minute weekly expressive writing compared to neutral writing; no effects were found on depressive symptoms. Mosher et al. (2012) examined the effect of expressive writing with 86 highly distressed patients with cancer for a longer period of time and also did not find effectiveness. Rodriguez-Vega et al. (2011) combined writing with escitalopram compared to escitalopram alone, and no difference was found in depressive symptoms.


Orientation and information provision provides general information about the disease, treatment, services, organization, staff members, and facility layout. In a systemic review of 25 studies (Husson, Mols, & van de Poll-Franse, 2011), patients reported better mental quality of life in follow-up. However, information provision did not benefit depression. Additional studies confirmed no effect (Chan, Webster, & Marquart, 2011; Wysocki, Mitús, Komorowski, & Karolewski, 2012).


In reflexology, pressure is applied to specific zones of the feet or hands to create a change in the related body part. Researchers have evaluated the effect of reflexology in managing various symptoms; randomized, controlled trials consistently reported no effect on depression (Sharp et al., 2010; Wyatt, Sikorskii, Rahbar, Victorson, & You, 2012).


Implications for Practice and Conclusion


Depression frequently occurs with anxiety in patients with cancer (Massie et al., 2011). Identified symptoms clusters include depression, fatigue, sleep disturbance, and pain (Miaskowski et al., 2006) and depressed mood, cognitive disturbance, fatigue, insomnia, and pain (Kim, Barsevick, Beck, & Dudley, 2012). Nurses can access evidence-based interventions for these symptoms from the Putting Evidence Into Practice website (www.ons.org/practice-resources/pep).


Attention to psychosocial concerns, such as depression, has increased recently, and this raised awareness has promoted the expectation that treatment teams identify emotional symptoms and integrate psychosocial care into oncology practice. Oncology nurses see patients time after time in hospitals, clinics, and infusion and radiation treatment rooms, often developing excellent rapport. As a result, oncology nurses are well positioned to identify, educate, and recommend interventions for which sufficient evidence exists. Although not all of the interventions for depression are within oncology nurses’ practice scope, they can establish referral resources of qualified practitioners based on an understanding of which interventions are most likely to benefit patients.


Many new studies, particularly nonpharmacologic interventions for depression, are appearing in the literature. With further study, more of those approaches may reach recommended effectiveness; evidence about timing of interventions on types and stages of cancers then may emerge. Nurses will ideally be among the researchers in those studies.


Implications for Practice


Ø  Help patients identify unhelpful thoughts and behaviors, and plan approaches for effective coping and problem solving.


Ø  Promote peer support through group-, disease-, or age-based organizations.


Ø  Identify symptom clusters in which depression is common and seek evidence-based interventions through Putting Evidence Into Practice resources.


The authors gratefully acknowledge Margaret Irwin, PhD, RN, Oncology Nursing Society research associate, for her assistance in all aspects of the search, review, classification, and manuscript preparation; Kerri A. Moriarty, MLS, Oncology Nursing Society research specialist; and past and present project team members Angelia Berkowitz, MSN, APRN, FNP-BC, Meghan Underhill, PhD, RN, AOCNS®, Patricia Friend, PhD, APRN, AOCN®, Diane Cope, PhD, RN, ARNP-BC, Thiruppavai Sundaramurthi, MSN, RN, CCRN, and Deborah Walker, DNP, FNP-BC, AOCN®, for their assistance in categorizing evidence.




Akechi, T., Ietsugu, T., Sukigara, M., Okamura, H., Nakano, T., Akizuki, N.., . . . Uchitomi, Y. (2009). Symptom indicator of severity of depression in cancer patients: A comparison of the DMS-IV criteria with alternative diagnostic criteria. General Hospital Psychiatry, 31, 225–232.


Akechi, T., Okuyama, T., Onishi, J., Morita, T., & Furukawa, T.A. (2008). Psychotherapy for depression among incurable cancer patients. Cochrane Database of Systematic Reviews, 2, CD005537. http://dx.doi.org/10.1002/14651858.CD005537.pub2


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.


Amodeo, L., Castelli, L., Leombruni, P., Cipriani, D., Biancofiore, A., & Torta, R. (2011). Slow versus standard up-titration of paroxetine for the treatment of depression in cancer patients: A pilot study. Supportive Care in Cancer, 20, 375–384.


Ando, M., Morita, T., Akechi, T., Ito, S., Tanaka, M., Ifuku, Y., & Nakayama, T. (2009). The efficacy of mindfulness-based meditation therapy on anxiety, depression, and spirituality in Japanese patients with cancer. Journal of Palliative Medicine, 12, 1091–1094. http://dx.doi.org/10.1089/jpm.2009.0143


Ashing, K., & Rosales, M. (2013). A telephonic-based trial to reduce depressive symptoms among Latina breast cancer survivors. Psycho-Oncology, 23, 507–515. http://dx.doi.org/10.1002/pon.3441


Australian Government National Health and Medical Research Council. (2003). Clinical practice guidelines for the psychosocial care of adults with cancer. Retrieved from http://www.nhmrc.gov.au/publications/synopses/cp90syn.htm


Badger, T.A., Segrin, C., Figueredo, A.J., Harrington, J., Sheppard, K., Passalacqua, S., . . . Bishop, M. (2011). Psychosocial interventions to improve quality of life in prostate cancer survivors and their intimate or family partners. Quality of Life Research, 20, 833–844. http://dx.doi.org/10.1007/s11136-010-9822-2


Bar-Sela, G., Atid, L., Danos, S., Gabay, N., & Epelbaum, R. (2007). Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psycho-Oncology, 6, 980–984.


Berglund, G., Petersson, L.M., Eriksson, K.C., Wallenius, I., Roshanai, A. Nordin, K.M., . . . Häggman, M. (2007). “Between Men”: A psychosocial rehabilitation programme for men with prostate cancer. Acta Oncologica, 46, 83–89. http://dx.doi.org/10.1080/02841860600857326


Beutel, M.E., Weißflog, G., Leuteritz, K., Wiltink, J., Haselbacher, A., Ruckes, C., . . . Brahler, E. (2014). Efficacy of short-term psychodynamic psychotherapy (STPP) with depressed breast cancer patients: Results of a randomized controlled multicenter trial. Annals of Oncology, 25, 378–384. http://dx.doi.org/10.1093/annonc/mdt526


Björneklett, H.G., Rosenblad, A., Lindemalm, C., Ojutkangas, M.L., Letocha, H., Strang, P., & Bergkvist, L. (2013). Long-term follow-up of a randomized study of support group intervention in women with primary breast cancer. Journal of Psychosomatic Research, 74, 346–353. http://dx.doi.org/10.1016/j.jpsychores.2012.11.005


Boesen, E.H., Karlsen, R., Christensen, J., Paaschburg, B., Nielsen, D., Bloch, I.S., . . . Johansen, C. (2011). Psychosocial group intervention for patients with primary breast cancer: A randomised trial. European Journal of Cancer, 47, 1363–1372. http://dx.doi.org/10.1016/j.ejca.2011.01.002.


Bower, J.E., Garet, D., Sternlieb, B., Ganz, P.A., Irwin, M.R., Olmstead, R., & Greendale, G. (2012). Yoga for persistent fatigue in breast cancer survivors: A randomized controlled trial. Cancer, 118, 3766–3775. http://dx.doi.org/10.1002/cncr.26702


Bradt, J., Dileo, C., Grocke, D., & Magill, L. (2011). Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, 8, CD006911. http://dx.doi.org/10.1002/14651858.CD006911.pub2


Brothers, B.M., Yang, H.C., Strunk, D.R., & Andersen, B.L. (2011). Cancer patients with major depressive disorder: Testing a biobehavioral/cognitive behavior intervention. Journal of Consulting and Clinical Psychology, 79, 253–260. http://dx.doi.org/10.1037/a0022566


Brown, J.C., Huedo-Medina, T.B., Pescatello, L.S., Ryan, S.M., Pescatello, S.M., Moker, E., . . . Johnson, B.T. (2012). The efficacy of exercise in reducing depressive symptoms among cancer survivors: A meta-analysis. PLOS One, 7, e30955.


Bruera, E., Yennurajalingam, S., Palmer, J.L., Perez-Cruz, P.E., Frisbee-Hume, S., Allo, J.A., . . . Cohen, M.Z. (2013). Methylphenidate and/or a nursing telephone intervention for fatigue in patients with advanced cancer: A randomized, placebo-controlled, phase II trial. Journal of Clinical Oncology, 31, 2421–2427. http://dx.doi.org/10.1200/JCO.2012.45.3696


Buffart, L.M., van Uffelen, J.G., Riphagen, I.I., Brug, J., van Mechelen, W., Brown, W.J., & Chinapaw, M.J. (2012). Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer, 12, 559. http://dx.doi.org/10.1186/1471-2407-12-559


Cankurtaran, E.S., Ozalp, E., Soygur, H., Akbiyik, D.I., Turhan, L., & Alkis, N. (2008). Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: Superiority over imipramine. Supportive Care in Cancer, 16, 1291–1298. http://dx.doi.org/10.1007/s00520-008-0425-1


Cantarero-Villanueva, I., Fernández-Lao, C., Cuesta-Vargas, A., Del Moral-Avila, R., Fernández-de-las-Peñas, C., & Arroyo-Morales, M. (2013). The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 94, 221–230. http://dx.doi.org/10.1016/j.apmr.2012.09.008


Carayol, M., Bernard, P., Boiche, J., Riou, F., Mercier, B., Cousson-Gelie, F., . . . Ninot, G. (2013). Psychological effect of exercise in women with breast cancer receiving adjuvant therapy: What is the optimal dose needed? Annals of Oncology, 24, 291–300. http://dx.doi.org/10.1093/annonc/mds342


Chan, R.J., Webster, J., & Marquart, L. (2011). Information interventions for orienting patients and their carers to cancer care facilities. Cochrane Database of Systematic Reviews, 12, CD008273. http://dx.doi.org/10.1002/14651858.CD008273.pub2


Chen, Z., Meng, Z., Milbury, K., Bei, W., Zhang, Y., Thornton, B., . . . Cohen, L. (2012). Qigong improves quality of life in women undergoing radiotherapy for breast cancer: Results of a randomized controlled trial. Cancer, 119, 1690–1698. http://dx.doi.org/10.1002/cncr.27904


Chien, C.H., Liu, K.L., Chien, H.T., & Liu, H.E. (2014). The effects of psychosocial strategies on anxiety and depression of patients diagnosed with prostate cancer: A systematic review. International Journal of Nursing Studies, 51, 28–38. http://dx.doi.org/10.1016/j.ijnurstu.2012.12.019


Chipperfield, K., Brooker, J., Fletcher, J., & Burney, S. (2013). The impact of physical activity on psychosocial outcomes in men receiving androgen deprivation therapy for prostate cancer: A systematic review. Health Psychology. Advanced online publication. http://dx.doi.org/10.1037/hea0000006


Craft, L.L., Vaniterson, E.H., Helenowski, I.F., Rademaker, A.W., & Courney, K.S. (2012). Exercise effects on depressive symptoms in cancer survivors: A systematic review and meta-analysis. Cancer Epidemiology, Biomarkers and Prevention, 21, 3–19.  http://dx.doi.org/10.1158/1055-9965.EPI-11-0634


Cramer, H., Lange, S., Klose, P., Paul, A., & Dobos, G. (2012). Yoga for breast cancer patients and survivors: A systematic review and meta-analysis. BMC Cancer, 12, 412. http://dx.doi.org/10.1186/1471-2407-12-412


da Costa Miranda, M.V., Trufelli, D.C., Santos, J., Campos, M.P., Nobuo, M., da Costa Miranda, M., . . . del Giglio, A. (2009). Effectiveness of guaraná (Paullinia cupana) for post radiation fatigue and depression: Results of a pilot double-blind randomized study. Journal of Alternative and Complementary Medicine, 15, 431–433. http://dx.doi.org/10.1089/acm.2008.0324


Deng, G., Chan, Y., Sjoberg, D., Vickers, A., Yeung, K.S., Kris, M., . . . Cassileth, B. (2013). Acupuncture for the treatment of post-chemotherapy chronic fatigue: A randomized, blinded, sham-controlled trial. Supportive Care in Cancer, 21, 1735–1741. http://dx.doi.org/10.1007/s00520-013-1720-z


Dhruva, A., Miaskowski, C., Abrams, D., Acree, M., Cooper, B., Goodman, S., & Hecht, F.M. (2012). Yoga breathing for cancer chemotherapy-associated symptoms and quality of life: Results of a pilot randomized controlled trial. Journal of Alternative and Complementary Medicine, 18, 473–479.


DiMatteo, M.R., & Haskard-Zolnierek, K.B. (2011). Impact of depression on treatment adherence and survival from cancer. In D.W. Kissane, M. Maj, & N. Sartorius, (Eds.), Depression and cancer (pp. 101–124). Oxford, UK: John Wiley and Sons.


D’Silva, S., Poscablo, C., Habousha, R., Kogan, M., & Kligler, B. (2012). Mind-body medicine therapies for a range of depression severity: A systematic review. Psychosomatics, 53, 407–423. http://dx.doi.org/10.1016/j.psym.2012.04.006


D’Souza, V., Blouin, E., Zeitouni, A., Muller, K., & Allison, P.J. (2012). An investigation of the effect of tailored information on symptoms of anxiety and depression in head and neck cancer patients. Oral Oncology, 49, 431–437. http://dx.doi.org/10.1016/j.oraloncology.2012.12.001


Ell, K., Xie, B., Kapetanovic, S., Quinn, D.I., Lee, P.J., Wells, A., & Chou, C.P. (2011). One-year follow-up of collaborative depression care for low-income, predominantly Hispanic patients with cancer. Psychiatric Services, 62, 162–170. http://dx.doi.org/10.1176/appi.ps.62.2.162


Ergun, M., Eyigor, S., Karaca, B., Kisim, A., & Uslu, R. (2013). Effects of exercise on angiogenesis and apoptosis-related molecules, quality of life, fatigue and depression in breast cancer patients. European Journal of Cancer Care, 22, 626–637. http://dx.doi.org/10.1111/ecc.12068


Ersoy, M.A., Noyan, A.M., & Elbi, H. (2008). An open-label long-term naturalistic study of mirtazapine treatment for depression in cancer patients. Clinical Drug Investigation, 28, 113–120.


Feng, Y., Wang, X.Y., Li, S.D., Zhang, Y., Wang, H.M., Li, M., . . . Zhang, Z. (2011). Clinical research of acupuncture on malignant tumor patients for improving depression and sleep quality. Journal of Traditional Chinese Medicine, 31, 199–202.


Fleming, L., Randell, K., Harvey, C.J., & Espie, C.A. (2014). Does cognitive behaviour therapy for insomnia reduce clinical levels of fatigue, anxiety and depression in cancer patients? Psycho-Oncology, 23, 679–684. http://dx.doi.org/10.1002/pon.3468


Frattaroli J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132, 823–865. http://dx.doi.org/10.1037/0033-2909.132.6.823


Fulcher, C.D., & Badger, T. (2009). Depression. In L.H. Eaton & J.M. Tipton (Eds.), Putting Evidence Into Practice: Improving oncology patient outcomes (pp. 105–118). Pittsburgh, PA: Oncology Nursing Society.


Fulcher, C.D., Badger, T., Gunter, A.K., Marrs, J.A., & Reese, J.M. (2008). Putting Evidence Into Practice: Interventions for depression. Clinical Journal of Oncology Nursing, 12, 131–140. http://dx.doi.org/10.1188/08.CJON.131-140


Gagnon, B., Murphy, J., Eades, M., Lemoignan, J., Jelowicki, M., Carney, S., . . . Macdonald, N. (2013). A prospective evaluation of an interdisciplinary nutrition-rehabilitation program for patients with advanced cancer. Current Oncology, 20, 31–318. http://dx.doi.org/10.3747/co.20.1612


Galantino, M.L., Callens, M.L., Cardena, G.J., Piela, N.L., & Mao, J.J. (2013). Tai chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: A feasibility study. Alternative Therapies in Health and Medicine, 19, 38–44.


Galway, K., Black, A., Cantwell, M., Cardwell, C.R., Mills, M., & Donnelly, M. (2012). Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database of Systematic Reviews, 11, CD007064. http://dx.doi.org/10.1002/14651858.CD007064.pub2


Garcia, M.K., McQuade, J., Haddad, R., Patel, S., Lee, R., Yang, P., . . . Cohen, L. (2013). Systematic review of acupuncture in cancer care: A synthesis of the evidence. Journal of Clinical Oncology, 31, 952–960. http://dx.doi.org/10.1200/JCO.2012.43.5818


Garland, S.N., Tamagawa, R., Todd, S.C., Speca, M., & Carlson, L.E. (2013). Increased mindfulness is related to improved stress and mood following participation in a mindfulness-based stress reduction program in individuals with cancer. Integrative Cancer Therapies, 12, 31–40. http://dx.doi.org/10.1177/1534735412442370


Gehring, K., Patwardhan, S.Y., Collins, R., Groves, M.D., Etzel, C.J., Meyers, C.A., & Wefel, J.S. (2012). A randomized trial on the efficacy of methylphenidate and modafinil for improving cognitive functioning and symptoms in patients with a primary brain tumor. Journal of Neuro-Oncology, 107, 165–174.


Girgis, A., Breen, S., Stacey, F., & Lecathelinais, C. (2009). Impact of two supportive care interventions on anxiety, depression, quality of life, and unmet needs in patients with nonlocalized breast and colorectal cancers. Journal of Clinical Oncology, 27, 6180–6190. http://dx.doi.org/10.1200/JCO.2009.22.8718


Given, C., Given, B., Rahbar, M., Jean, S., McCorkle, R., & Cimprich, B. (2004). Does a symptom management intervention affect depression among cancer patients: Results from a clinical trial? Psycho-Oncology, 13, 818–830.


Goerling, U., Foerg, A., Sander, S., Schramm, N., & Schlag, P.M. (2011). The impact of short-term psycho-oncological interventions on the psychological outcome of cancer patients of a surgical-oncology department. A randomized controlled study. European Journal of Cancer, 47, 2009–2014.


Gong, S., Sheng, P., Jin, H., He, H., Qi, E., Chen, W., . . . Hou, L. (2014). Effect of methylphenidate in patients with cancer-related fatigue: A systematic review and meta-analysis. PLOS One, 9, e84391. http://dx.doi.org/10.1371/journal.pone.0084391


Gotay, C.C., Moinpour, C.M., Unger, J.M., Jiang, C.S., Coleman, D., Martino, S., . . . Albain, K.S. (2007). Impact of a peer-delivered telephone intervention for women experiencing a breast cancer recurrence. Journal of Clinical Oncology, 25, 2093–2099. http://dx.doi.org/10.1200/JCO.2006.07.4674


Greer, J.A., Traeger, L., Bemis, H., Solis, J., Hendriksen, E.S., Park, E.R., . . . Safren, S.A. (2012). A pilot randomized controlled trial of brief cognitive-behavioral therapy for anxiety in patients with terminal cancer. Oncologist, 17, 1337–1345. http://dx.doi.org/10.1634/theoncologist.2012-0041


Griffiths, K.M., Calear, A.L., & Banfield, M. (2009). Systematic review on internet support groups (ISGs) and depression (1): Do ISGs reduce depressive symptoms? Journal of Medical Internet Research, 11, e40. http://dx.doi.org/10.2196/jmir.1270


Groarke, A., Curtis, R., & Kerin, M. (2013). Cognitive-behavioural stress management enhances adjustment in women with breast cancer. British Journal of Health Psychology, 18, 623–641. http://dx.doi.org/10.1111/bjhp.12009


Guo, Z., Tang, H.Y., Li, H., Tan, S.K., Feng, K.H., Huang, Y.C., . . . Jiang, W. (2013). The benefits of psychosocial interventions for cancer patients undergoing radiotherapy. Health and Quality of Life Outcomes, 11, 121. http://dx.doi.org/10.1186/1477-7525-11-121


Hanna, L.R., Avila, P.F., Meteer, J.D., Nicholas, D.R., & Kaminsky, L.A. (2008). The effects of a comprehensive exercise program on physical function, fatigue, and mood in patients with various types of cancer. Oncology Nursing Forum, 35, 461–469. http://dx.doi.org/10.1188/08.ONF.461-469


Hanssens, S., Luyten, R., Watthy, C., Fontaine, C., Decoster, L., Baillon, C., . . . De Grève, J. (2011). Evaluation of a comprehensive rehabilitation program for post-treatment patients with cancer [Online exclusive]. Oncology Nursing Forum, 38, E418–E424. http://dx.doi.org/10.1188/11.ONF.E418-E424


Harder, H., Parlour, L., & Jenkins, V. (2012). Randomised controlled trials of yoga interventions for women with breast cancer: A systematic literature review. Supportive Care in Cancer, 20, 3055–3064. http://dx.doi.org/10.1007/s00520-012-1611-8


Hart, S.L., Hoyt, M.A., Diefenbach, M., Anderson, D.R., Kilbourn, K.M., Craft, L.L., . . . Stanton, A.L. (2012). Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. Journal of the National Cancer Institute, 104, 990–1004. http://dx.doi.org/10.1093/jnci/djs256


Herschbach, P., Berg, P., Waadt, S., Duran, G., Engst-Hastreiter, U., Henrich, G., . . . Dinkel, A. (2010). Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychotherapy and Psychosomatics, 79, 31–38. http://dx.doi.org/10.1159/000254903


Hofmann, S.G., Sawyer, A.T., Witt, A.A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 169–183. http://dx.doi.org/10.1037/a0018555


Hopko, D.R., Armento, M.E., Robertson, S.M., Ryba, M.M., Carvalho, J.P., Colman, L.K., . . . Lejuez, C.W. (2011). Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: Randomized trial. Journal of Consulting and Clinical Psychology, 79, 834–849. http://dx.doi.org/10.1037/a0025450


Husson, O., Mols, F., & van de Poll-Franse, L.V. (2011), The relation between information provision and health-related quality of life, anxiety and depression among cancer survivors: A systematic review. Annals of Oncology, 22, 761–772. http://dx.doi.org/10.1093/annonc/mdq413


Jacobsen, P.B., Phillips, K.M., Jim, H.S., Small, B.J., Faul, L.A., Meade, C.D., . . . Wilson, R.W. (2013). Effects of self-directed stress management training and home-based exercise on quality of life in cancer patients receiving chemotherapy: A randomized controlled trial. Psycho-Oncology, 22, 1229–1235. http://dx.doi.org/10.1002/pon.3122


Jensen-Johansen, M.B., Christensen, S., Valdimarsdottir, H., Zakowski, S., Jensen, A.B., Bovbjerg, D.H., & Zachariae, R. (2012). Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors—Results from a nationwide randomized clinical trial. Psycho-Oncology, 22, 1492–1500. http://dx.doi.org/10.1002/pon.3193


Kangas, M., Milross, C., Taylor, A., & Bryant, R.A. (2012). A pilot randomized controlled trial of a brief early intervention for reducing posttraumatic stress disorder, anxiety and depressive symptoms in newly diagnosed head and neck cancer patients. Psycho-Oncology, 22, 1665–1673. http://dx.doi.org/10.1002/pon.3208


Kao, C.Y., Hu, W.Y., Chiu, T.Y., & Chen, C.Y. (2014). Effects of the hospital-based palliative care team on the care for cancer patients: An evaluation study. International Journal of Nursing Studies, 51, 226–235.


Khan, F., Amatya, B., Pallant, J.F., Rajapaksa, I., & Brand, C. (2012). Multidisciplinary rehabilitation in women following breast cancer treatment: A randomized controlled trial. Journal of Rehabilitation Medicine, 44, 788–794. http://dx.doi.org/10.2340/16501977-1020


Kim, H.J., Barsesvick, A., Beck, S.L., & Dudley, W. (2012). Clinical subgroups of a psychoneurologic symptom cluster in women receiving treatment for breast cancer: A secondary analysis [Online exclusive]. Oncology Nursing Forum, 39, E20–E29. http://dx.doi.org/10.1188/12.ONF.E20-E30


Kim, Y.H., Kim, H.J., Ahn, S.D., Seo, Y.J., & Kim, S.H. (2013). Effects of meditation on anxiety, depression, fatigue, and quality of life of women undergoing radiation therapy for breast cancer. Complementary Therapies in Medicine, 21, 379–387. http://dx.doi.org/10.1016/j.ctim.2013.06.005


Kleiboer, A., Bennett, F., Hodges, L., Walker, J., Thekkumpurath, P., & Sharpe, M. (2011). The problems reported by cancer patients with major depression. Psycho-Oncology, 20, 62–68.


Klemm, P. (2012). Effects of online support group format (moderated vs peer-led) on depressive symptoms and extent of participation in women with breast cancer. Computers, Informatics, Nursing, 30, 9–18. http://dx.doi.org/10.1097/NCN.0b013e3182343efa


Kligler, B., Homel, P., Harrison, L.B., Sackett, E., Levenson, H., Kenney, J., . . . Merrell, W. (2011). Impact of the Urban Zen Initiative on patients’ experience of admission to an inpatient oncology floor: A mixed-methods analysis. Journal of Alternative and Complementary Medicine, 17, 729–734. http://dx.doi.org/10.1089/acm.2010.0533


Komatsu, H., Hayashi, N., Suzuki, K., Yagasaki, K., Iioka, Y., Neumann, J., . . . Ueno, N.T. (2012). Guided self-help for prevention of depression and anxiety in women with breast cancer. ISRN Nursing, 2012, 716367. http://dx.doi.org/10.5402/2012/716367


Korstjens, I., Mesters, I., May, A.M., van Weert, E., van den Hout, J.H., Ros, W., . . . van den Borne, B. (2011). Effects of cancer rehabilitation on problem-solving, anxiety and depression: A RCT comparing physical and cognitive-behavioural training versus physical training. Psychology and Health, 1, 63–82. http://dx.doi.org/10.1080/08870441003611569


Kroenke, K., Theobald, D., Wu, J., Norton, K., Morrison, G., Carpenter, J., & Tu, W. (2010). Effect of telecare management on pain and depression in patients with cancer: A randomized trial. JAMA, 304, 163–171. http://dx.doi.org/10.1001/jama.2010.944


Krohn, M., Listing, M., Tjahjono, G., Reisshauer, A., Peters, E., Klapp, B.F., & Rauchfuss, M. (2011). Depression, mood, stress, and Th1/Th2 immune balance in primary breast cancer patients undergoing classical massage therapy. Supportive Care in Cancer, 19, 1303–1311. http://dx.doi.org/10.1007/s00520-010-0946-2


Kwiatkowski, F., Mouret-Reynier, M.A., Duclos, M., Leger-Enreille, A., Bridon, F., Hahn, T., . . . Bignon, Y.J. (2013). Long term improved quality of life by a 2-week group physical and educational intervention shortly after breast cancer chemotherapy completion. Results of the ‘Programme of accompanying women after breast cancer treatment completion in thermal resorts’ (PACThe) randomised clinical trial of 251 patients. European Journal of Cancer, 49, 1530–1538. http://dx.doi.org/10.1016/j.ejca.2012.12.021


Laoutidis, Z.G., & Mathiak, K. (2013). Antidepressants in the treatment of depression/depressive symptoms in cancer patients: Asystematic review and meta-analysis. BMC Psychiatry, 13, 140. http://dx.doi.org/10.1186/1471-244X-13-140


Lengacher, C.A., Reich, R.R., Post-White, J., Moscoso, M., Shelton, M.M., Barta, M., . . . Budhrani, P. (2012). Mindfulness based stress reduction in post-treatment breast cancer patients: An examination of symptoms and symptom clusters. Journal of Behavioral Medicine, 35, 86–94. http://dx.doi.org/10.1007/s10865-011-9346-4.


Li, W.H., Chung, J.O., & Ho, E.K. (2011). The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. Journal of Clinical Nursing, 20, 2135–2143. http://dx.doi.org/10.1111/j.1365-2702.2011.03733.x


Liu, C.J., Hsiung, P.C., Chang, K.J., Liu, Y.F., Wang, K.C., Hsiao, F.H., . . . Chan, C.L. (2008). A study on the efficacy of body-mind-spirit group therapy for patients with breast cancer. Journal of Clinical Nursing, 17, 2539–2549. http://dx.doi.org/10.1111/j.1365-2702.2008.02296.x


Lloyd-Williams, M., Cobb, M., O’Connor, C., Dunn, L., & Shiels, C. (2012). A pilot randomized controlled trial to reduce suffering and emotional distress in patients with advanced cancer. Journal of Affective Disorders, 148, 141–145. http://dx.doi.org/10.1016/j.jad.2012.11.013


Low, C.A., Stanton, A.L., Bower, J.E., & Gyllenhammer, L. (2010). A randomized controlled trial of emotionally expressive writing for women with metastatic breast cancer. Health Psychology, 29, 460–466. http://dx.doi.org/10.1037/a0020153


Luebbert, K., Dahme, B., & Hasenbring, M. (2001). The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: A meta-analytical review. Psycho-Oncology, 10, 490–502. http://dx.doi.org/10.1002/pon.537


Lutgendorf, S.K., Mullen-Houser, E., Russell, D., Degeest, K., Jacobson, G., Hart, L., . . . Lubaroff, D.M. (2010). Preservation of immune function in cervical cancer patients during chemoradiation using a novel integrative approach. Brain, Behavior, and Immunity, 24, 1231–1240. http://dx.doi.org/10.1016/j.bbi.2010.06.014


Lydiatt, W.M., Bessette, D., Schmid, K.K., Sayles, H., & Burke, W.J. (2013). Prevention of depression with escitalopram in patients undergoing treatment for head and neck cancer: Randomized, double-blind, placebo-controlled clinical trial. JAMA Otolaryngology, 139, 678–686. http://dx.doi.org/10.1001/jamaoto.2013.3371


Lydiatt, W.M., Denman, D., McNeilly, D.P., Puumula, S.E., & Burke, W.J. (2008). A randomized, placebo-controlled trial of citalopram for the prevention of major depression during treatment for head and neck cancer. JAMA Otolaryngology, 134, 528–535.


Massie, M.J. (2004). Prevalence of depression in patients with cancer. Journal of the National Cancer Institute. Monographs, 32, 57–71. http://dx.doi.org/10.1093/jncimonographs/lgh014


Massie, M.J., Lloyd-Williams, M., Irving, G., & Miller, K. (2011). The prevalence of depression in people with cancer. In D.W. Kissane, M. Maj, & N. Sartorius (Eds.), Depression and cancer (pp. 1–36). Oxford, UK: John Wiley and Sons.


McMillan, S.C., Small, B.J., & Haley, W.E. (2011). Improving hospice outcomes through systematic assessment. Cancer Nursing, 34, 89–97. http://dx.doi.org/10.1097/NCC.0b013e3181f70aee


Mehnert, A., Veers, S., Howaldt, D., Braumann, K.M., Koch, U., & Schulz, K.H. (2011). Effects of a physical exercise rehabilitation group program on anxiety, depression, body image, and health-related quality of life among breast cancer patients. Onkologie, 34, 248–253. http://dx.doi.org/10.1159/000327813


Meijer, A., Roseman, M., Milette, K., Coyne, J.C., Stefanek, M.E., Ziegelstein, R.C., . . . Thombs, B.D. (2011). Depression screening and patient outcomes in cancer: A systematic review. PLoS One, 6, e27181. http://dx.doi.org/10.1371/journal.pone.0027181


Miaskowski, C., Cooper, B.A., Paul, S.M., Dodd, M., Lee, K., Aouizerat, B.E., . . . Bank, A. (2006). Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: A cluster analysis [Online exclusive]. Oncology Nursing Forum, 33, E79–E89. http://dx.doi.org/10.1188/06.ONF.E79-E89


Midtgaard, J., Rørth, M., Stelter, R., Tveterås, A., Andersen, C., Quist, M., . . . Adamsen, L. (2005). The impact of a multidimensional exercise program on self-reported anxiety and depression in cancer patients undergoing chemotherapy: A phase II study. Palliative and Supportive Care, 3, 197–208.


Milbury, K., Chaoul, A., Biegler, K., Wangyal, T., Spelman, A., Meyers, C.A., . . . & Cohen, L. (2013). Tibetan sound meditation for cognitive dysfunction: Results of a randomized controlled pilot trial. Psycho-Oncology, 22, 2354–2363. http://dx.doi.org/10.1002/pon.3296


Miller, K., & Massie, M.J. (2006). Depression and anxiety. Cancer Journal, 12, 388–397. http://dx.doi.org/10.1097/00130404-200609000-00008


Miller, K., & Massie, M.J. (2010). Depressive disorders. In J.C. Holland, W.S. Breitbart, P.B. Jacobsen, M.S. Lederberg, M.J. Loscalzo, & R. McCorkle (Eds.), Psycho-oncology (2nd ed., pp. 311–318). New York, NY: Oxford University Press.


Mitchell, S.A., & Friese, C.R. (n.d.). ONS PEP (Putting Evidence into Practice) weight of evidence classification schema. Decision rules for summative evaluation of a body of evidence. Retrieved from http://www2.ons.org/Research/media/ons/docs/research/outcomes/weight-of-evidence-table.pdf


Molassiotis, A., Bardy, J., Finnegan-John, J., Mackereth, P., Ryder, D.W., Filshie, J., . . . Richardson, A. (2012). Acupuncture for cancer-related fatigue in patients with breast cancer: A pragmatic randomized controlled trial. Journal of Clinical Oncology, 30, 4470–4476. http://dx.doi.org/10.1200/JCO.2012.41.6222


Molassiotis, A., Bardy, J., Finnegan-John, J., Mackereth, P., Ryder, W.D., Filshie, J., . . . Richardson, A. (2013). A randomized controlled trial of acupuncture self-needling as maintenance therapy for cancer related fatigue after therapist delivered acupuncture. Annals of Oncology, 24, 1645–1652. http://dx.doi.org/10.1093/annonc/mdt034


Mosher, C.E., Duhamel, K.N., Lam, J., Dickler, M., Li, Y., Massie, M.J., & Norton, L. (2012). Randomised trial of expressive writing for distressed metastatic breast cancer patients. Psychology and Health, 27, 88–100. http://dx.doi.org/10.1080/08870446.2010.551212


Naaman, S.C., Radwan, K., Fergusson, D., & Johnson, S. (2009). Status of psychological trials in breast cancer patients: A report of three meta-analyses. Psychiatry, 72, 50–69. http://dx.doi.org/10.1521/psyc.2009.72.1.50


National Cancer Institute. (2013). Depression (PDQ®) health professional version. Retrieved from http://www.cancer.gov/cancertopics/pdq/supportivecare/depression/HealthProfessional/


National Comprehensive Cancer Network. (2013). NCCN Clinical Practice Guidelines in Oncology: Distress management [v.2.2013]. Retrieved from http://www.nccn.org/professionals/physican_gls/pdf/distress.pdf


Navari, R.M., Brenner, M.C., & Wilson, M.N. (2008). Treatment of depressive symptoms in patients with early stage breast cancer undergoing adjuvant therapy. Breast Cancer Research and Treatment, 112, 197–201. http://dx.doi.org/10.1007/s10549-007-9841-z


Nunes, D.F., Rodriguez, A.L., da Silva Hoffmann, F., Luz, C., Braga Filho, A.P., Muller, M.C., & Bauer, M.E. (2007). Relaxation and guided imagery program in patients with breast cancer undergoing radiotherapy is not associated with neuroimmunomodulatory effects. Journal of Psychosomatic Research, 63, 647–655. http://dx.doi.org/10.1016/j.jpsychores.2007.07.004


Osborn, R.L., Demoncada, A.C., & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: Meta-analyses. International Journal of Psychiatry in Medicine, 36, 13–34.


Park, H.Y., Lee, B.J., Kim, J.H., Bae, J.N., & Hahm, B.J. (2012). Rapid improvement of depression and quality of life with escitalopram treatment in outpatients with breast cancer: A 12-week, open-label prospective trial. Progress in Neuropsychopharmacology and Biological Psychiatry, 30, 318–323. http://dx.doi.org/10.1016/j.pnpbp.2011.11.010


Payne, J.K., Held, J., Thorpe, J., & Shaw, H. (2008). Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal therapy. Oncology Nursing Forum, 35, 635–642. http://dx.doi.org/10.1188/08.ONF.635-642


Piet, J., Würtzen, H., & Zachariae, R. (2012). The effect of mindfulness-based therapy on symptoms of anxiety and depression in adult cancer patients and survivors: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 80, 1007–1020. http://dx.doi.org/10.1037/a0028329


Pirl, W.F., Greer, J.A., Traeger, L., Jackson, V., Lennes, I.T., Gallagher, E.R., . . . Temel, J.S. (2012). Depression and survival in metastatic non-small-cell lung cancer: Effects of early palliative care. Journal of Clinical Oncology, 30, 1310–1315. http://dx.doi.org/10.1200/JCO.2011.38.3166


Pitceathly, C., Maguire, P., Fletcher, I., Parle, M., Tomenson, B., & Creed, F. (2009). Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomised controlled trial. Annals of Oncology, 20, 928–934. http://dx.doi.org/10.1093/annonc/mdn708


Post-White, J., Kinney, M.E., Savik, K., Gau, J.B., Wilcox, C., & Lerner, I. (2003). Therapeutic massage and healing touch improve symptoms in cancer. Integrative Cancer Therapies, 2, 332–344. http://dx.doi.org/10.1177/1534735403259064


Potter, P.J. (2007). Breast biopsy and distress: Feasibility of testing a Reiki intervention. Journal of Holistic Nursing, 25, 238–248.


Qiu, J., Chen, W., Gao, X., Xu, Y., Tong, H., Yang, M., . . . Yang, M. (2013). A randomized controlled trial of group cognitive behavioral therapy for Chinese breast cancer patients with major depression. Journal of Psychosomatic Obstetrics and Gynaecology, 34, 60–67. http://dx.doi.org/10.3109/0167482X.2013.766791


Quintard, B., & Lakdja, F. (2008). Assessing the effect of beauty treatments on psychological distress, body image, and coping: A longitudinal study of patients undergoing surgical procedures for breast cancer. Psycho-Oncology, 17, 1032–1038. http://dx.doi.org/10.1002/pon.1321


Raison, C.L., Rutherford, R.E., Woolwine, B.J., Shuo, C., Schettler, P., Drake, D.F., . . . Miller, A.H. (2013). A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression. JAMA Psychiatry, 70, 31–41. http://dx.doi.org/10.1001/2013.jamapsychiatry.4


Rajasekaran, M., Edmonds, P.M., & Higginson, I.L. (2005). Systematic review of hypnotherapy for treating symptoms in terminally ill adult cancer patients. Palliative Medicine, 19, 418–426.  http://dx.doi.org/10.1191/0269216305pm1030oa


Ram, S., Narayanasamy, R., & Barua, A. (2013). Effectiveness of group psycho-education on well-being and depression among breast cancer survivors of Melaka, Malaysia. Indian Journal of Palliative Care, 19, 34–39. http://dx.doi.org/10.4103/0973-1075.110234


Ramachandra, P., Booth, S., Pieters, T., Vrotsou, K., & Huppert, F.A. (2009). A brief self-administered psychological intervention to improve well-being in patients with cancer: Results from a feasibility study. Psycho-Oncology, 18, 1323–1326. http://dx.doi.org/10.1002%2Fpon.1516


Rayner, L., Price, A., Evans, A., Valsraj, K., Higginson, I.J., & Hotopf, M. (2010). Antidepressants for depression in physically ill people. Cochrane Database of Systematic Reviews, 17, CD007503. http://dx.doi.org/10.1002/14651858.CD007503.pub2


Rodriguez-Vega, B., Palao, A., Torres G., Hospital, A., Benito, G., Pérez, E., . . . Bayón, C. (2011). Combined therapy versus usual care for the treatment of depression in oncologic patients: A randomized controlled trial. Psycho-Oncology, 20, 943–952. http://dx.doi.org/10.1002/pon.1800


Rottmann, N., Dalton, S.O., Bidstrup, P.E., Würtzen, H., Høybye, M.T., Ross, L., . . . Johansen, C. (2012). No improvement in distress and quality of life following psychosocial cancer rehabilitation. A randomised trial. Psycho-Oncology, 21, 505–514. http://dx.doi.org/10.1002/pon.1924


Saarto, T., Penttinen, H.M., Sievänen, H., Kellokumpu-Lehtinen, P.L., Hakamies-Blomqvist, L., Nikander, R., . . . Luoma, M.L. (2012). Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors. Anticancer Research, 32, 3875–3884.


Satin, J.R., Linden, W., & Phillips, M.J. (2009). Depression as a predictor of disease progression and mortality in cancer patients: A meta-analysis. Cancer, 115, 5349–5361. http://dx.doi.org/10.1002/cncr.24561


Serfaty, M., Wilkinson, S., Freeman, C., Mannix, K., & King, M. (2012). The ToT study: Helping with Touch or Talk (ToT): A pilot randomised controlled trial to examine the clinical effectiveness of aromatherapy massage versus cognitive behaviour therapy for emotional distress in patients in cancer/palliative care. Psycho-Oncology, 21, 563–569. http://dx.doi.org/10.1002/pon.1921


Sharma, M., Haider, T., & Knowlden, A.P. (2013). Yoga as an alternative and complementary treatment for cancer: A systematic review. Journal of Alternative and Complementary Medicine, 19, 870–875. http://dx.doi.org/10.1089/acm.2012.0632


Sharp, D.M., Walker, M.B., Chaturvedi, A., Upadhyay, S., Hamid, A., Walker, A.A., . . . Walker, L.G. (2010). A randomized, controlled trial of the psychological effects of reflexology in early breast cancer. European Journal of Cancer, 46, 312–322. http://dx.doi.org/10.1016/j.ejca.2009.10.006


Sharplin, G.R., Jones, S.B., Hancock, B., Knott, V.E., Bowden, J.A., & Whitford, H.S. (2010). Mindfulness-based cognitive therapy: An efficacious community-based group intervention for depression and anxiety in a sample of cancer patients. Medical Journal of Australia, 193, S79–S82.


Steginga, S.K., Pinnock, C., Gardner, M., Gardiner, R.A., & Dunn, J. (2005). Evaluating peer support for prostate cancer: The prostate cancer peer support inventory. British Journal of Urology, 95, 46–50. http://dx.doi.org/10.1111/j.1464-410X.2005.05247.x


Strong, V., Waters, R., Hibberd, C., Murray, G., Wall, L., Walker, J., . . . Sharpe, M. (2008). Management of depression for people with cancer (SMaRT oncology 1): A randomised trial. Lancet, 372, 40–48. http://dx.doi.org/10.1016/S0140-6736(08)60991-5


Suzuki, N., Ninomiya, M., Maruta, T., Hosonuma, S., Yoshioka, N., Ohara, T., . . . Ishizuka, B. (2011). Clinical study on the efficacy of fluvoxamine for psychological distress in gynecologic cancer patients. International Journal of Gynecological Cancer, 21, 1143–1149. http://dx.doi.org/10.1097/IGC.0b013e3181ffbeb9


Thyme, K.E., Sundin, E.C., Wiberg, B., Oster, I., Aström, S., & Lindh, J. (2009). Individual brief art therapy can be helpful for women with breast cancer: A randomized controlled clinical study. Palliative and Supportive Care, 7, 87–95. http://dx.doi.org/10.1017/S147895150900011X


Torta, R., Leombruni, P., Borio, R., & Castelli, L. (2011). Duloxetine for the treatment of mood disorder in cancer patients: A 12-week case-control clinical trial. Human Psychopharmacology, 26, 291–299. http://dx.doi.org/10.1002/hup.1202


Torta, R., Siri, I., & Caldera, P. (2008). Sertraline effectiveness and safety in depressed oncological patients. Supportive Care in Cancer, 16, 83–91. http://dx.doi.org/10.1007/s00520-007-0269-0


Van der Meulen, I.C., May, A.M., Ros, W.J., Oosterom, M., Hordijk, G.J., Koole, R., & de Leeuw, J.R. (2013). One-year effect of a nurse-led psychosocial intervention on depressive symptoms in patients with head and neck cancer: A randomized controlled trial. Oncologist, 18, 336–344. http://dx.doi.org/10.1634/theoncologist.2012-0299


Vos, P.J., Visser, A.P., Garssen, B., Duivenvoorden, H.J., & de Haes, H. (2007). Effectiveness of group psychotherapy compared to social support groups in patients with primary, non-metastatic breast cancer. Journal of Psychosocial Oncology, 25, 37–60. http://dx.doi.org/10.1300/J077v25n04_03


Walker, J., Sawhney, A., Hansen, C.H., Ahmed, S., Martin, P., Symeonides, S., . . . Sharpe, M. (2013). Treatment of depression in adults with cancer: A systematic review of randomized controlled trials. Psychological Medicine, 44, 897–907. http://dx.doi.org/10.1017/S0033291713001372


Weber, B.A., Roberts, B.L., Yarandi, H., Mills, T.L., Chumbler, N.R., & Wajsman, Z. (2007). The impact of dyadic social support on self-efficacy and depression after radical prostatectomy. Journal of Aging and Health, 19, 630–645. http://dx.doi.org/10.1177/0898264307300979


White, V.M., Macvean, M.L., Grogan, S., D’Este, C., Akkerman, D., Ieropoli, S., . . . Sanson-Fisher, R. (2012). Can a tailored telephone intervention delivered by volunteers reduce the supportive care needs, anxiety and depression of people with colorectal cancer? A randomised controlled trial. Psycho-Oncology, 21, 1053–1062. http://dx.doi.org/10.1002/pon.2019


Würtzen, H., Dalton, S.O., Elsass, P., Sumbundu, A.D., Steding-Jensen, M., Karlsen, R.V., . . . Johansen, C. (2013). Mindfulness significantly reduces self-reported levels of anxiety and depression: Results of a randomised controlled trial among 336 Danish women treated for stage I–III breast cancer. European Journal of Cancer, 49, 1365–1373.


Wyatt, G., Sikorskii, A., Rahbar, M.H., Victorson, D., & You, M. (2012). Health-related quality-of-life outcomes: A reflexology trial with patients with advanced-stage breast cancer. Oncology Nursing Forum, 39, 568–577. http://dx.doi.org/10.1188/12.ONF.568-577


Wysocki, W.M., Mitus, J., Komorowski, A.L., & Karolewski, K. (2012). Impact of preoperative information on anxiety and disease-related knowledge in women undergoing mastectomy for breast cancer: A randomized clinical trial. Acta Chirurgica Belgica, 112, 111–115.


Yang, C.Y., Tsai, J.C., Huang, Y.C., & Lin, C.C. (2010). Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy. Journal of Advanced Nursing, 67, 158–168.


Yim, V.W., Ng, A.K., Tsang, H.W., & Leung, A.Y. (2009). A review on the effects of aromatherapy for patients with depressive symptoms. Journal of Alternative and Complementary Medicine, 15, 187–195. http://dx.doi.org/10.1089/acm.2008.0333


Zhang, J., Yang, K.H., Tian, J.H., & Wang, C.M. (2012). Effects of yoga on psychologic function and quality of life in women with breast cancer: A meta-analysis of randomized controlled trials. Journal of Alternative and Complementary Medicine, 18, 994–1002. http://dx.doi.org/10.1089/acm.2011.0514


Zhou, K.N., Li, X.M., Yan, H., Dang, S.N., & Wang, D.L. (2011). Effects of music therapy on depression and duration of hospital stay of breast cancer patients after radical mastectomy. Chinese Medical Journal, 124, 2321–2327.


Zimmermann, T., Heinrichs, N., & Baucom, D.H. (2007). Does one size fit all? Moderators in psychosocial interventions for breast cancer patients: A meta-analysis. Annals of Behavioral Medicine, 34, 225–239. http://dx.doi.org/10.1007/BF02874548


Caryl D. Fulcher, MSN, RN, PMHCNS-BC, is a clinical nurse specialist at Duke University Hospital in Durham, NC; Hee-Ju Kim, PhD, RN, OCN®, is an assistant professor in the College of Nursing at Catholic University of Korea in Seoul; Patsy R. Smith, PhD, RN, is an assistant professor in the College of Nursing at the University of Oklahoma Health Sciences Center in Oklahoma City; and Tammie L. Sherner, MSN, APRN-CNS, BC, is an advanced oncology practice nurse at the Saint Alphonsus Regional Medical Center in Boise, ID. The authors take full responsibility for the content of the article. The authors did not receive honoraria for this work. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or editorial staff. Fulcher can be reached at caryl.fulcher@duke.edu, with copy to editor at CJONEditor@ons.org. (Submitted May 2014. Revision submitted July 2014. Accepted for publication July 7, 2014.)


Key words: depression; cancer; interventions