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Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer
  1. Chris Lo1,2,
  2. Sarah Hales1,2,
  3. Aubrey Chiu1,
  4. Tania Panday1,
  5. Carmine Malfitano1,
  6. Judy Jung1,
  7. Anne Rydall1,
  8. Madeline Li1,2,
  9. Rinat Nissim1,2,
  10. Camilla Zimmermann1,2,3 and
  11. Gary Rodin1,2
  1. 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  2. 2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Gary Rodin, Department of Supportive Care, 16–724, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9; Gary.Rodin{at}


Background Managing Cancer And Living Meaningfully (CALM) is a brief individual psychotherapy for patients with advanced cancer. In an intervention-only phase 2a trial, CALM showed promising results, leading to the present 2b pilot, which introduces procedures for randomisation and improved rigour in preparation for a phase 3 randomised controlled trial (RCT).

Aims To test trial methodology and assess feasibility of a confirmatory RCT.

Design A parallel-arm RCT (intervention vs usual care) with 3 and 6-month follow-ups. Assessment of feasibility included rates of consent, randomisation, attrition, intervention non-compliance and usual care contamination. Primary outcome: depressive symptoms (Patient Health Questionnaire-9; PHQ-9). Secondary outcomes: major depressive disorder (MDD), generalised anxiety, death anxiety, spiritual well-being, attachment anxiety and avoidance, self-esteem, experiential avoidance, quality of life and post-traumatic growth. Bayesian conjugate analysis was used in this low-powered setting.

Setting/participants 60 adult patients with advanced cancer from the Princess Margaret Cancer Centre.

Results Rate of consent was 32%, randomisation 78%, attrition 25%, non-compliance 37% and contamination 17%. There was support for potential treatment effects on: PHQ-9, OR=1.48, 95% Credible Interval (CRI.95) (0.65, 3.38); MDD, OR=1.56, CRI.95 (0.50, 4.84); attachment anxiety, OR=1.72, CRI.95 (0.73, 4.03); and attachment avoidance, OR=1.58, CRI.95 (0.67, 3.71). There was no support for effects on the seven remaining secondary outcomes.

Conclusions A phase 3 CALM RCT is feasible and should aim to detect effect sizes of d=0.40, with greater attention to issues of compliance and contamination.

Trial registration number NCT02353546.

  • Terminal care
  • Cancer
  • Psychological care
  • Supportive care

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