Feasibility and Preliminary Effectiveness of Behavioral Activation for Patients with Cancer and Depression in Japan

Takatoshi Hirayama; Yuko Ogawa; Yuko Yanai; Akie Shindo; Moeko Tanaka; Shin-Ichi Suzuki

doi:10.1089/pmr.2023.0020

Feasibility and Preliminary Effectiveness of Behavioral Activation for Patients with Cancer and Depression in Japan

Palliat Med Rep. 2023 Jun 23;4(1):150-160. doi: 10.1089/pmr.2023.0020. eCollection 2023.

Authors

Takatoshi Hirayama¹, Yuko Ogawa¹, Yuko Yanai¹, Akie Shindo², Moeko Tanaka³, Shin-Ichi Suzuki⁴

Affiliations

¹ Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan.
² Department of Palliative Care, National Center for Global Health and Medicine, Tokyo, Japan.
³ Department of Psychology and Welfare, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
⁴ Faculty of Human Sciences, Waseda University, Saitama, Japan.

Abstract

Background: Though the effectiveness of behavioral activation (BA) for patients with cancer and depression were reported, there is no evidence in Japan.

Objectives: This study aimed at examining the feasibility and preliminary effectiveness of BA for patients with cancer and depression in Japan.

Methods: This pre-post study without a control group was conducted in patients with cancer and depression in Japan. The program completion rate was compared with those of previous studies to examine feasibility. To examine the preliminary effectiveness, outcomes were evaluated four times: before and immediately after the program, and two weeks and three months after the program ended. The primary outcome was the remission rate of depression using the 17-item version of the GRID Hamilton Rating Scale for Depression (HAMD₁₇). Secondary outcomes were self-reported depression, anxiety, quality of life, changes in behavior, values, and perceived reward of activity and environmental factors. Pre- and post-program data were compared using paired-samples t-tests, and data obtained at four time points were analyzed using one-way repeated-measures analysis of variance.

Results: Of the 68 patients recruited from February 2018 to January 2022, 32 were registered. The completion rate was 75% (24/32), which was similar to previous studies. The total HAMD₁₇ score significantly improved after the program. The remission rate of depression was 62.5% (20/32), which was above the defined threshold value (30%). All but two secondary outcomes significantly improved after the program (p < 0.05).

Conclusions: The feasibility and preliminary effectiveness of BA for patients with cancer and depression in Japan were suggested.

The Clinical Trial Registration number: UMIN 000036104.

Keywords: Psycho-Oncology; behavioral activation; cancer patients; depression; psychotherapy.