Electroconvulsive therapy for obsessive compulsive symptoms in a patient with schizophrenia: a brief report.

Comorbid obsessive-compulsive disorder (OCD) is common among patients with schizophrenia. The role of electroconvulsive therapy (ECT) in the treatment of OCD in schizophrenia is unclear. Herein, we present a 45-year-old man who was diagnosed with schizophrenia along with OCD and received ECT due to relapse of psychosis owing to refractive schizophrenia. Together with psychotic symptoms, obvious symptoms of OCD were observed prior to treatment, including obsessive thoughts, difficulty in starting activities, and repetitive and ritualistic behavior. After 12 sessions of ECT, symptoms of schizophrenia and OCD both improved significantly (Positive and Negative Syndrome Scale [PANSS] score decreased from 95 points to 58 points, and Yale - Brown Obsessive-Compulsive Scale [Y-BOCS] score decreased from 29 points to 11 points). Mild aggravation of OCD symptoms was noted 3 months after ECT treatment (Y-BOCS score increased from 11 points to 17 points) without obvious relapse of psychotic symptoms (PANSS score changed from 58 points to 62 points). In conclusion, ECT could be considered as an alternative therapy for patients with schizophrenia and OCD with limited response to pharmacological treatment.

Predictive value of the Distress Thermometer score for risk of suicide in patients with cancer.

PURPOSE: This study aimed to assess the association between the Distress Thermometer (DT) score and risk of suicide in patients with cancer. In addition, we aimed to determine the best cutoff score to predict patients at risk of suicide. METHODS: From 2015 to 2016, we retrospectively collected data on patients with cancer. DT scores were collected, and the association between DT score and risk of suicide (suicide ideation or death ideation) was analyzed. Furthermore, receiver operating characteristic (ROC) analysis was performed to identify the appropriate cutoff score for predicting risk of suicide. RESULTS: A total of 260 patients with cancer were included, and suicidal ideation was identified in 33 cases referred for psychological intervention. The DT scores of the patients with suicidal ideation were significantly higher than those of patients without suicidal ideation (6.30±2.11 vs. 4.29±1.72, p<0.05). In addition, the area under the ROC curve for predicting risk for suicide was 0.758. The cutoff DT score of 3 had the highest sensitivity of 1.00 to rule out suicidal ideation, while 9 had the highest specificity of 1.00 to rule in suicidal ideation. Moreover, the appropriate cutoff DT score to predict patients with suicidal ideation was 5, with a sensitivity of 0.52, specificity of .84, positive likelihood ratio of 3.24, and negative likelihood ratio of 0.58. CONCLUSION: The DT score may be a helpful clinical tool to evaluate emotional distress and risk of suicide in patients with cancer. Clinically, for DT scores greater than 5 in patients with cancer, the risk of suicide greatly increases. In view of the DT's widespread use internationally by non-mental health clinicians in cancer to guide the need for specialist mental health interventions, its potential utility in also predicting suicide risk is of great interest.

Evaluating a multicomponent survivorship programme for men with prostate cancer in Australia: a single cohort study.

OBJECTIVE: To evaluate the implementation of a multicomponent survivorship programme for men with prostate cancer and their carers. DESIGN: A single cohort study, guided by the RE-AIM framework. SETTING: Multiple health services in Australia. PARTICIPANTS: Men with prostate cancer and their carers, and health professionals. INTERVENTION: A 12-month telehealth programme that provided centralised and coordinated decision and information support, exercise and nutrition management, specialised clinical support and practical support to men and their carers. DATA COLLECTION: Multiple sources of data including participant-reported health outcomes and experience of care, qualitative interviews, records of the programme were collected at different time points. RESULTS: Reach: Of 394 eligible men at various stages of survivorship, 142 consented (36% consent rate) and 136 (96%) completed the programme. Adoption: All men participated in general care coordination and more than half participated in exercise and/or nutrition management interventions. Participation in the specialised support component (ie, psychosocial and sexual health support, continence management) was low despite the high level of need reported by men. Effectiveness: Overall, the men reported improvements in their experience of care. Implementation: Factors such as addressing service gaps, provision of specialised services, care coordination, adoption of needs-based and telehealth-based approaches were identified as enablers to the successful implementation of the programme. Issues such as insufficient integration with existing services, lack of resources and high caseload of the intervention team, men's reluctance to discuss needs and lack of confidence with technology were barriers in implementing the programme. CONCLUSION: Survivorship interventions are relevant to men regardless of the stage of their disease and treatments undertaken. It is possible to provide access to a comprehensive model of survivorship care to promote the health and quality of life for men with prostate cancer. TRIAL REGISTRATION NUMBER: This study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12617000174381).

An integrated multicomponent care model for men affected by prostate cancer: A feasibility study of TrueNTH Australia.

OBJECTIVE: To evaluate the feasibility of implementing an integrated multicomponent survivorship care model for men affected by prostate cancer. METHODS: Using a single arm prospective cohort study design, men with prostate cancer were recruited from two regional public hospitals in Australia for a 6-months program that provided information and decision support, exercise and nutrition management, specialised clinical support, and practical support through localised and central care coordination. Carers of the men were also invited to the program. Data were collected from multiple sources to evaluate: (1) recruitment capability and participant characteristics; (2) appropriateness and feasibility of delivering the specific intervention components using an electronic care management tool; and (3) suitability of data collection procedures and proposed outcome measures. RESULTS: Of the 105 eligible men, 51 (consent rate 49%) participated in the program. Of the 31 carers nominated by the men, 13 consented (consent rate 42%). All carers and 50 (98%) men completed the program. Most (92%) men were newly diagnosed with localised prostate cancer. All men attended initial screening and assessment for supportive care needs; a total of 838 episodes of contact/consultation were made by the intervention team either in person (9%) or remotely (91%). The intervention was implemented as proposed with no adverse events. The proposed outcome measures and evaluation procedures were found to be appropriate. CONCLUSIONS: Our results support the feasibility of implementing this integrated multicomponent care model for men affected by prostate cancer.

An evaluation of the practice of electroconvulsive therapy (ECT) in a Victorian health service before and after the Mental Health Act 2014.

OBJECTIVE: The aim of the project was to identify changes in the practice of electroconvulsive therapy (ECT) in a metropolitan mental health service before and after the Mental Health Act 2014 (2014 Act) in Victoria. METHOD: Retrospective clinical file audit of ECT administration across all three sites at Eastern Health (EH) two years before and two years after introduction of the 2014 Act. RESULTS: There was a statistically significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT across the three hospitals at EH in the two years following the 2014 Act compared to the two years prior to the 2014 Act. There was no significant difference in the number of voluntary ECT treatments and in the number of patients who had voluntary ECT. CONCLUSION: The review showed that there has been a significant decrease in the number of compulsory ECT treatments and in the number of patients who had compulsory ECT after the introduction of the 2014 Act. Potential reasons for the changes are discussed.

How many patients enter endometrial cancer surgery with psychotropic medication prescriptions, and how many receive a new prescription perioperatively?

OBJECTIVE: Psychotropic medications including antidepressants and anxiolytics are used to treat anxiety and depression in cancer patients; however, little is known about the prescription practices in endometrial cancer. This study aimed to determine the prevalence, type, dose, frequency and timing of psychotropic medications prescribed to endometrial cancer patients. A secondary aim was to study sociodemographic and clinical characteristics associated with receiving a psychotropic medication prescription. METHODS: Secondary data analysis of an international, multicentre, prospective randomised controlled trial was conducted. Patients aged >18 years diagnosed with Stage I endometrial cancer were included. Logistic regression models were fitted to estimate the association of receiving psychotropic medications with patient's socio-demographic and clinical characteristics. RESULTS: The overall prevalence of patients prescribed one or more psychotropic medications was 16.8% (n = 121/719) comprising antidepressants (12.6%, n = 91/719) and anxiolytics (5.8%, n = 42/719). The majority of patients (78.1%, n = 71/91) were already receiving antidepressants before cancer diagnosis, the remaining medications were newly prescribed perioperatively (21.9%, n = 20/91). Patients of younger age (18-50 years, OR (Odds Ratio): 2.61), who had hypertension (OR: 0.61), history of a previous cancer (OR: 1.96), and ≥2 comorbidities (2-3, OR: 2.97; 4-5, OR: 7.85; ≥6, OR: 9.13) were significantly (p < 0.05) more likely to receive a prescription of psychotropic medications. CONCLUSIONS: While one in eight patients already had psychotropic medications prescribed before surgery for early stage endometrial cancer, only few women received a new prescription after surgery. The overall prescription rates were similar to other patients with cancer, but higher than those observed in the general population, likely reflecting the comorbidity burden of patients who develop endometrial cancer. Qualitative data could be used in future research to explore the psychological and quality of life impacts of endometrial cancer.

Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta-analyses.

OBJECTIVE: The aims of this meta-analysis were to estimate the overall effect size (ES) of psychological interventions on anxiety in patients with cancer and extract sample and intervention characteristics that influence effectiveness. METHODS: PubMed, Scopus, PsycINFO, Embase, Medline, and CINAHL were searched using Medical Subject Heading keywords 'cancer' AND 'anxiety' AND 'psychological intervention' AND 'counselling' AND 'psycho*' AND 'psychotherapy' AND 'psychosocial' AND 'therapy' between January 1993 and June 2017. RESULTS: Seventy-one studies were eligible for the systematic review; among them, 51 studies were included in the meta-analysis calculations. The overall ES was -0.21 (95% confidence interval; -0.30 to -0.13) in favour of the intervention. From subgroup analyses, studies conducted in Asia, enrolling inpatients, focussing on relaxation, of <6-week intervention duration, <30-minute intervention dose per session, and <4 hours of total time of intervention showed moderate ESs ranging from -0.40 to -0.55. Only 2 studies restricted enrolment to prescreened patients with clinically elevated level of anxiety and showed moderate ES of -0.58. CONCLUSIONS: Low psychological distress at baseline and nonevidence-based interventions were the main factors identified for low effectiveness. Screening and assessment to determine clinical levels of anxiety in patients with cancer should be considered in future trials as an inclusion criterion before providing psychological interventions. Systematic review registration: PROSPERO: International Prospective Register of Systematic Reviews: CRD42017056132.

Exploring the experiences and psychosocial stresses of Taiwanese patients with pulmonary hypertension: a qualitative interview study.

About half of all patients with pulmonary hypertension (PH) experience psychological and emotional disturbances that affect their quality of life (QOL). There is a lack of studies exploring how psychiatric professionals can provide specific and effective mental health treatment to patients with PH. This study aimed to explore and understand the treatment experiences of patients with PH in Taiwan. We employed an exploratory qualitative design involving interviews with 17 patients with PH who were treated at Kaohsiung Veterans General Hospital in Taiwan. Participants were interviewed by a psychiatrist; the interviews were audiotaped and transcribed for thematic analysis by two researchers. We corroborate earlier findings showing that patients who have the rare disease PH often experience psychological or emotional disturbances throughout the treatment process. This study explored a model for psychiatric intervention based on patients' experience of having PH. We find that assessing and strengthening links to external resources can enhance patients' long-term coping abilities, and thereby help reduce their psychological and emotional disturbances and improve their QOL.

What type and dose of antidepressants are cancer and non-cancer inpatients being prescribed: a retrospective case-control study at an Australian tertiary hospital.

PURPOSE: Cancer patients are often prescribed antidepressants, but little data is available about whether the type and dose are similar to prescriptions to patients with other chronic diseases. This study compared the prescription practices of antidepressants to cancer and non-cancer inpatients at a major Australian tertiary hospital and assessed side effects and potential drug-drug interactions. METHODS: Inpatients diagnosed with cancer within the past 12 months and prescribed antidepressants were age and gender matched to inpatients with other chronic disease conditions. Data from 75 cancer and 75 non-cancer inpatients were extracted. RESULTS: Antidepressants were prescribed to cancer and non-cancer patients, respectively, for the treatment of depression (n = 50 vs n = 59), other mental health problems (n = 8 vs n = 11, p < 0.67) or unspecified reasons (n = 17 vs n = 5, p < 0.02). Mirtazapine (n = 11/75) was most commonly prescribed to cancer patients followed by duloxetine (n = 9/75). Desvenlafaxine (n = 15/75) was prescribed most commonly to non-cancer inpatients, followed by mirtazapine (n = 11/75). Four cancer patients and three non-cancer patients had documented adverse side effects from antidepressants. About one-third of cancer patients (n = 23/75) and about a quarter of non-cancer patients (n = 18/75) were prescribed other medicines with the potential for drug-drug interactions with antidepressants. CONCLUSIONS: Antidepressants were prescribed for a range of indications in all patients, but more commonly for unspecified reasons among the cancer patients. Future prospective studies that monitor antidepressant prescribing to cancer patients should ascertain details of the indication, pathways to prescription and differences in type, dose or schedule depending on prescribing medical practitioner.

A systematic review and meta-analysis of prescribing practices of antidepressants in cancer patients.

BACKGROUND: Antidepressants are commonly used for the pharmacological treatment of depression. We aimed to summarise the prevalence of antidepressant prescription to cancer patients, and differences by study or patient characteristics. METHODS: PubMed, Embase, Web of Science, Scopus and psychINFO were searched using keywords 'psychotropic', 'antidepressants', 'prescription' and 'cancer'. Prevalence of antidepressants, type, dose and follow-up of antidepressants and prescriber details were extracted. RESULTS: Overall, 1537 articles between 1979 and February 2015 were found, 38 met the inclusion criteria and were reviewed according to PRISMA guidelines. The prevalence rate of prescribing antidepressants to cancer patients was 15.6% (95% CI = 13.3-18.3). Prescription was significantly less common in studies from Asia (7.4%; 95% CI = 4.3-12.5), more common in female (22.6%; 95% CI = 16.0-31.0) or breast cancer patients (22.6%; 95% CI = 16.0-30.9). Selective serotonin reuptake inhibitors were the most frequently prescribed antidepressants. General practitioners and psychiatrists, followed by oncologists, were identified as the major providers of antidepressant prescriptions to cancer patients. Few studies reported the exact dose, length of time drugs were prescribed for or follow-up regimens. CONCLUSIONS: There is considerable variation in the prescribing patterns of antidepressants across the world, with few studies reporting robust data on exact dose or follow-up regimens. Prospective studies that monitor antidepressant prescribing, including details of reasons for prescribing and the healthcare providers involved, dose, change in dose or type of medication and follow-up are needed to ascertain whether patients are being treated optimally and if side effects or drug-drug interactions are identified and managed. Copyright © 2016 John Wiley & Sons, Ltd.

Cognitive existential couple therapy (CECT) in men and partners facing localised prostate cancer: a randomised controlled trial.

OBJECTIVES: To assess the efficacy of cognitive existential couple therapy (CECT) for relationship function, coping, cancer distress and mental health in men with localised prostate cancer and in their partners. PATIENTS SUBJECTS AND METHODS: A randomised controlled trial was conducted with 62 couples randomly assigned to the six-session CECT programme or care as usual. The couple's relationship function (primary outcome), and coping, cancer distress and mental health (secondary outcomes) were evaluated at T0 (baseline), T1 (after treatment) and T2 (9 months from T0). A repeated-measures analysis of covariance model, which incorporated T0 measurements as a covariate, was used to compare treatment groups at T1 and T2. RESULTS: After CECT, patients reported significantly greater use of adaptive coping (P = 0.03) and problem-focused coping (P = 0.01). These gains were maintained at follow-up, while relationship cohesion had improved (P = 0.03), as had relationship function for younger patients (P = 0.01). Younger partners reported less cancer-specific distress (P = 0.008), avoidance (P = 0.04), intrusive thought (P = 0.006), and hyperarousal (P = 0.01). Gains were maintained at follow-up, while relationship cohesion (P = 0.007), conflict resolution (P = 0.01) and relational function (P = 0.009) all improved. CONCLUSION: CECT resulted in improved coping for patients and lower cancer-distress for partners. Maintained over time this manifests as improved relationship function. CECT was acceptable to couples, alleviated long-term relationship decline, and is therefore suitable as a preventative mental health intervention for couples facing prostate cancer. Given resourcing demands, we recommend dissemination of CECT be targeted at younger couples, as CECT was more acceptable to the younger group, and they derived greater benefit from it.

Comparison of the acceptability and benefits of two mindfulness-based interventions in women with breast or gynecologic cancer: a pilot study.

PURPOSE: The aim of this study was to compare the relative benefits and acceptability of two different group-based mindfulness psychotherapy interventions among women with breast and gynecologic cancer. METHODS: Data from 42 women who completed an 8-week mindfulness-based cognitive therapy (MBCT) program comprising 22 contact hours were compared to data from 24 women who completed a 6-week mindfulness meditation program (MMP) comprising 9 contact hours. Distress, quality of life (QOL), and mindfulness were evaluated pre- (T1) and post-intervention (T2). ANCOVA was used to analyse the relationship between intervention type and T1 score on outcome variable change scores. Participants' perceptions of benefit and acceptability were assessed. RESULTS: The participants did not differ on clinical or demographic variables other than MBCT participants were more likely than MMP participants to have a past history of anxiety or depression (p = .01). Scores on distress, QOL, and mindfulness improved from T1 to T2 with medium to large effect sizes for the MMP (p=.002, d=.7; p=.001, d=.8; p=.005, d=.6, respectively) and MBCT (p<.001,d = .6; p=.008, d = .4; p<.001, d=.9, respectively) interventions. [correted]. ANCOVA showed no main effect for intervention type on outcome change scores and no interaction between intervention type and respective T1 score. Distress and mindfulness scores at T1 had a main effect on respective change scores (p = .02, ηp (2) = .87; p = .01, ηp (2) = .80, respectively). Both programs were perceived as beneficial and acceptable with no differences between the intervention types. CONCLUSIONS: Within the limits of a small, non-randomized study, these findings provide preliminary support for the utility of a brief mindfulness intervention for improving distress and QOL in a heterogeneous group of women with cancer. Abbreviated interventions are less resource intensive and may be attractive to very unwell patients.

Understanding the experiences of Mandarin-speaking patients diagnosed with life-threatening cancer in Australia.

OBJECTIVE: People from ethnic minority groups who receive cancer care outside their country of origin may experience poor survival and psychological outcomes relative to that nation's majority groups. This exploratory qualitative study aimed to understand the experience of a large minority group of Mandarin-speaking cancer patients (MSCPs) after diagnosis and treatment of their cancer in Australia, with a view to delineate if cultural or linguistic factors affected the quality of care provided. METHOD: We employed an exploratory qualitative design involving interviews with 22 MSCPs who were treated during 2009 at the Peter MacCallum Cancer Centre (PMCC) in Melbourne, Australia. Participants were interviewed by a bilingual psychiatrist, audiotaped, transcribed in Mandarin, and then translated into English before being subjected to thematic analysis by two independent researchers. RESULTS: MSCPs experienced notable challenges as a result of both language difficulties and differing cultural approaches, which often limited their understanding of their disease and impeded their ability to access quality care and adequate support. The results call for Australia and other Western nations with increasingly diverse populations to consider how cancer care can be modified to better support people from minority groups to effectively cope with their diagnosis and treatment. SIGNIFICANCE OF RESULTS: This study raises several suggestions for service improvement, including the development of bilingual communication aids, improved educational opportunities for clinical staff to aid their mastery of cultural issues and effective interpreter consultations, and improved access to supportive services offering culturally specific strategies.

Teaching psychiatry to undergraduates: peer-peer learning using a "GP letter".

OBJECTIVE: The authors describe a novel peer-peer learning activity with medical students, encompassing a specialist psychiatrist-general practitioner (GP) dyadic interchange of letters, and a group discussion facilitated by a GP and a psychiatrist to enhance students' appreciation of the complexities of psychiatric assessment and formulation, emphasize the importance of the GP in the comprehensive longitudinal care of people with a mental illness, and improve students' written communication skills. METHODS: Quantitative and qualitative methods were employed to evaluate the activity. RESULTS: Twenty-eight fifth-year medical students undertook the learning activity; of these, 20 completed the questionnaires and 18 participated in the focus groups. Quantitative feedback was good, with most agreeing or strongly agreeing that the activity met the learning objectives. The qualitative outcomes suggested the students found the exercise relevant and useful in clarifying their communication style regarding a patient with a psychiatric problem. CONCLUSIONS: The use of peer-peer learning using a "GP letter" can go some way towards meeting a number of teaching and learning challenges pertinent to psychiatry.

Mindfulness-based cognitive group therapy for women with breast and gynecologic cancer: a pilot study to determine effectiveness and feasibility.

PURPOSE: Group-based mindfulness training is frequently described in psycho-oncology literature, but little is known of the effectiveness of mindfulness-based cognitive therapy (MBCT). We investigated the effectiveness and acceptability of MBCT for women with breast and gynecologic cancer. METHODS: Fifty women were recruited to participate in eight weekly 2-h mindfulness sessions. Outcomes of distress, quality of life (QOL), post-traumatic growth, and mindfulness were assessed pre-intervention, post-intervention, and again 3 months later using validated measures. Data were analyzed with repeated measures ANOVAs with a Bonferroni correction. Participant satisfaction and evaluation were also assessed. RESULTS: Forty-two women completed the program, and complete data were available for 36 women. Significant improvements with large effect sizes (ηρ(2)) were observed for distress (P < 0.001; ηρ(2) = 0.238), QOL (P = 0.001; ηρ(2) = 0.204), mindfulness (P < 0.001; ηρ(2) = 0.363) and post-traumatic growth (P < 0.001; ηρ(2) = 0.243). Gains were maintained 3 months post-intervention. Improvements in outcomes did not differ based on diagnostic group, psychological status, or physical well-being at entry. Change indices further support these findings. Scores on measures of distress, QOL, and post-traumatic growth decreased as a function of increased mindfulness at each time point (all P < 0.05). Participants reported experiencing the program as beneficial, particularly its group-based nature, and provided positive feedback of the therapy as a whole as well as its individual components. CONCLUSIONS: Within the limits of a non-randomized trial, these findings provide preliminary support for the potential psychosocial benefits of MBCT in a heterogeneous group of women with cancer. Future, more comprehensive trials are needed to provide systematic evidence of this therapy in oncology settings.

A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer.

OBJECTIVE: The aim of the study was to assess symptoms of depression and anxiety in patients with head and neck cancer up to 18 months after radiotherapy. METHODS: Prospective observational study of consecutive head and neck outpatients was conducted at a tertiary cancer centre (n = 101). Eligibility included diagnosis of cancer in the head and neck region, where the patient agreed to radiotherapy with curative intent. Data were collected before commencement of radiotherapy and 3 weeks and 18 months after completion. Symptoms of depression and anxiety were assessed by the Hospital Anxiety and Depression Scale. Tumour/treatment-related physical symptoms were assessed using the 'Additional Concerns' subscale of the Functional Assessment of Chronic Illness Therapy for Head and Neck Cancer. RESULTS: The prevalence of identified probable cases of depression was 15% at baseline, increasing to 29% 3 weeks post-treatment, falling to 8% at 18-month follow-up. The number of probable cases of anxiety was 20% at baseline, 17% at 3 weeks post-treatment and 22% at 18-month follow-up. Depression scores significantly increased from baseline to 3 weeks post-treatment and decreased at 18-month follow-up. Variability in depression scores was accounted for by tumour/treatment-related physical symptoms. Anxiety scores significantly decreased between baseline and 3-week post-treatment and increased at 18-month follow-up. Younger age and more tumour/treatment-related physical symptoms predicted anxiety scores. CONCLUSIONS: The rates of depression in head and neck cancer patients increase following cancer treatment and are related to tumour/treatment-related physical symptoms. Anxiety levels are higher pre-treatment, lower immediately following cancer treatment but rise to near pre-treatment levels more than a year after completion of cancer treatment.

Cognitive Existential Couple Therapy for newly diagnosed prostate cancer patients and their partners: a descriptive pilot study.

OBJECTIVE: This paper aims to describe 'Cognitive Existential Couple Therapy' (CECT), a novel couples-based intervention for men with early stage prostate cancer (PCa) and their partners, and to report preliminary findings from a pilot study that investigated the acceptability and feasibility of the intervention and the measures to be used in a subsequent randomised controlled trial. METHODS: A manualised CECT programme was delivered to 12 couples facing a diagnosis of PCa within the previous 12 months by psychiatrists and clinical psychologists. Participants completed measures of psychological distress, marital function and coping pattern before and after CECT. Semi-structured interviews were conducted with nine couples shortly after the completion of CECT. RESULTS: The application of CECT was both feasible and acceptable as indicated by favourable participant compliance (10 of the 12 couples attended all six designated sessions), completion of measures before and after CECT and participation in semi-structured interviews by nine couples. Preliminary results included reduced levels of avoidance and hyperarousal after the programme, with this effect stronger in partners than in patients. Interviews demonstrated that couples valued the therapist's contribution to their overall care. CONCLUSIONS: Previous research suggests that a couple-focused psychological intervention is desirable in the context of early stage PCa. This pilot study has established that CECT is acceptable, feasible and valued by couples facing a recent PCa diagnosis and demonstrates a potential for reduced psychological distress following CECT. A randomised controlled trial is currently being undertaken to validate the efficacy of this novel approach.

Depression and cancer.

Depression in patients with cancer can present a challenging clinical problem for both general practitioners and the oncology team. Detecting depression in a patient with cancer, who may be debilitated and in pain, can be difficult. Cancer treatments can complicate antidepressant choices. Community-based psychologists are an important resource for helping manage less complex and less severe psychological problems that can arise in the cancer setting. Specialist psycho-oncology services (where available) can help with more complex and severe presentations of depression by advising on the prescription of antidepressants and providing psychotherapy programs that address the patient's psychological orientation and needs and consider the patient's cancer type and stage.

The practical challenges of recruitment and retention when providing psychotherapy to advanced breast cancer patients.

GOALS OF WORK: The goal of the present study was to investigate recruitment issues relevant to psychotherapy trials for metastatic cancer patients. First, we undertook a literature review of the psychotherapy intervention research for metastatic cancer patients. Second, we piloted pragmatic recruitment methods for a couples' intervention for women with metastatic breast cancer and their partners. METHODS: An extensive literature search was conducted to identify psychotherapy trials involving people with metastatic cancer published in peer-reviewed journals. Study characteristics and recruitment methodologies were examined. In the pilot study, we trialled the recruitment strategies of approaching participants at outpatients' appointments, via letter, referral from the treating team and through direct advertising using two community support services. RESULTS: The literature search identified 1,905 potentially relevant articles, which were narrowed to 18 studies specifically involving metastatic cancer patients involving a professionally trained facilitator and a specified theoretical orientation. Limited information was found on recruitment rates and the success of recruitment strategies. Barriers to recruitment identified in the literature included degree of patient illness, lack of interest/perceived benefit, insufficient time, socio-demographic factors and negative clinician attitudes. Our pilot study identified 72 eligible couples of which 66 were approached. Our recruitment strategies resulted in six couples consenting (9.1%) but only three couples completing the study (4.5%). The main reasons for study refusal were the intervention was not needed, lack of interest, insufficient time, patient illness and travel distance. CONCLUSIONS: Recruitment for couple-based psychotherapy interventions is challenging. More work is required on developing acceptable and feasible recruitment processes for metastatic cancer patients to be able to access support.