BACKGROUND Depression is one of the most common mental disorders in people with advanced cancer. Although cognitive-behavioural therapy (CBT) has been shown to be effective for depression in people with cancer, it is unclear whether this is the case for people with advanced cancer and depression. AIMS We sought to determine whether CBT is more clinically effective than treatment as usual (TAU) for treating depression in people with advanced cancer (trial registration number ISRCTN07622709). METHOD A multi-centre, parallel-group single-blind randomised controlled trial comparing TAU with CBT (plus TAU). Participants (n = 230) with advanced cancer and depression were randomly allocated to (a) up to 12 sessions of individual CBT or (b) TAU. The primary outcome measure was the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Patient Health Questionnaire-9, the Eastern Cooperative Oncology Group Performance Status, and Satisfaction with Care. RESULTS Multilevel modelling, including complier-average intention-to-treat analysis, found no benefit of CBT. CBT delivery was proficient, but there was no treatment effect (-0.84, 95% CI -2.76 to 1.08) or effects for secondary measures. Exploratory subgroup analysis suggested an effect of CBT on the BDI-II in those widowed, divorced or separated (-7.21, 95% CI -11.15 to -3.28). CONCLUSIONS UK National Institute for Health and Care Excellence (NICE) guidelines recommend CBT for treating depression. Delivery of CBT through the Improving Access to Psychological Therapies (IAPT) programme has been advocated for long-term conditions such as cancer. Although it is feasible to deliver CBT through IAPT proficiently to people with advanced cancer, this is not clinically effective. CBT for people widowed, divorced or separated needs further exploration. Alternate models of CBT delivery may yield different results. DECLARATION OF INTEREST M.S. is a member of the Health Technology Assessment General Board.

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认知行为疗法对晚期癌症抑郁症的有效性：CanTalk 随机对照试验

背景 抑郁症是晚期癌症患者最常见的精神障碍之一。尽管认知行为疗法 (CBT) 已被证明对癌症患者的抑郁症有效，但尚不清楚晚期癌症和抑郁症患者是否也是这种情况。目的 我们试图确定 CBT 在治疗晚期癌症患者的抑郁症方面是否比常规治疗 (TAU) 更有效（试验注册号 ISRCTN07622709）。方法 一项多中心、平行组单盲随机对照试验，比较 TAU 与 CBT（加 TAU）。患有晚期癌症和抑郁症的参与者 (n = 230) 被随机分配到 (a) 最多 12 次个人 CBT 或 (b) TAU。主要结果测量是贝克抑郁量表-II (BDI-II)。次要结果测量包括患者健康问卷 9、东部肿瘤合作小组表现状态和护理满意度。结果 多层次建模，包括编译器平均意向治疗分析，未发现 CBT 的益处。CBT 提供是熟练的，但没有治疗效果（-0.84，95% CI -2.76 至 1.08）或次要措施的效果。探索性亚组分析表明，CBT 对丧偶、离婚或分居者的 BDI-II 有影响（-7.21，95% CI -11.15 至 -3.28）。结论 英国国家健康与护理卓越研究所 (NICE) 指南推荐 CBT 治疗抑郁症。通过改善获得心理治疗的机会 (IAPT) 计划提供 CBT 已被提倡用于治疗癌症等长期疾病。尽管通过 IAPT 熟练地向晚期癌症患者提供 CBT 是可行的，但这在临床上并不有效。针对丧偶、离婚或分居者的 CBT 需要进一步探索。CBT 交付的替代模型可能会产生不同的结果。利益声明 MS 是卫生技术评估委员会的成员。