Retrospective comparison of cognitive behavioral therapy and symptom-specific medication to treat anxiety and depression in throat cancer patients after laryngectomy

BACKGROUND: Laryngectomy, a common treatment for laryngeal cancer, is a disabling operation that can induce tremendous stress, but little is known about how to alleviate the psychological effects of the operation. AIM: Compare the effectiveness of cognitive behavioral therapy (CBT) and medication in treating anxiety and depression among throat cancer patients after laryngectomy. METHODS: Review of medical records of the psychological outpatient clinic in the Third People’s Hospital of Huzhou City between March 2009 and May 2013 identified 63 patients with post-laryngectomy depression or anxiety disorders who received 8 weeks of one-on-one treatment with CBT (in which patients responded in writing because they were unable to speak) and 56 patients who received 8 weeks of treatment with buspirone (n=11), sertraline (n=9) or both busipirone and sertraline (n=36). The treatment provided (CBT or medications) was based on the stated preference of the patient. The Zung Self-rating Anxiety Scale (SAS) and the Zung Self-rating Depression Scale (SDS) were administered before and after treatment. RESULTS: After 8 weeks of treatment the mean SAS and SDS scores had decreased significantly in both groups and the prevalence of clinically significant anxiety and depression (based on SAS and SDS cutoff scores) had dropped dramatically. There were, however, no significant differences between the two treatment methods. In the medication group 32% of participants experienced one or more adverse reactions during treatment, but none of these were severe enough to require withdrawal from treatment. CONCLUSIONS: CBT is an effective, short-term treatment for reducing the anxiety and depressive symptoms that often occur after an individual is diagnosed with cancer or treated for cancer. There is robust evidence that treatment of these psychological symptoms can improve both the quality of life and course of illness in cancer patients, so oncologists and other clinicians need to regularly screen patients with cancer and other chronic life-threatening conditions for anxiety and depression and, if present, actively promote the treatment of these symptoms. This study shows that CBT can be effective for cancer patients even when they are unable to speak.