Randomised controlled trial of a tailored, cognitive behavioural approach intervention for anxiety and depression in people with COPD (TANDEM)

Clinical Research Results Abstract Introduction:Anxiety and depression are common comorbidities in people with chronic obstructive pulmonary disease (COPD). A recent review [1] found psychological approaches may be effective in treating COPD-related depression but the evidence was limited and of poor quality. Cognitive behavioural approaches (CBA) could potentially increase uptake of pulmonary rehabilitation (PR) enabling synergies that could enhance the psychological wellbeing of people with COPD. We developed a tailored, CBA-based psychological intervention for people with anxiety or depression and COPD (TANDEM) [2] - here we present its evaluation.Methods:Individual patient, assessor-blind RCT compared TANDEM with usual care (randomisation ratio 1.25:1) [3]. The CBA-based TANDEM intervention (x6-8, 40-60 minute sessions plus telephone support) was delivered by 31 trained respiratory healthcare professionals individually to participants with moderate to very severe COPD and symptoms of anxiety and/or depression prior to commencing PR. Usual care participants received routine PR referral. Co-primary outcomes were Hospital Anxiety and Depression Scale anxiety and depression scores (HADS-A, HADS-D) six months post-randomisation. Secondary outcomes at 6m and 12m included: St George’s Respiratory Questionnaire (SGRQ), social engagement, healthcare resource use, completion of PR, smoking cessation and cost effectiveness.Results423 participants were randomised (intervention 242; control 181). Follow up at 6- and 12-months was 93% and 82%. Despite good fidelity for intervention delivery, mean between-group differences (MD) in HADS at 6-months ruled out clinically important effects (MD (95% CI): HADS-A -0.60 (-1.40; 0.21); HADS-D -0.66 (-1.39; 0.07)) with similar results at 12-months. There were no between-group differences in any of the secondary outcomes. DiscussionThe tailored CBA intervention delivered with fidelity by trained respiratory healthcare professionals to people with COPD was neither clinically nor cost-effective. Different approaches are required to address co-morbid anxiety and depression in people with advanced COPD and to support uptake of, and retention in, PR programmes. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest References and Clinical Trial Registry Information Pollok J, et al. Psychological therapies for the treatment of depression in chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD012347.Steed L, et al. Developing a complex intervention whilst considering implementation: the TANDEM (Tailored intervention for ANxiety and DEpression Management) intervention for patients with chronic obstructive pulmonary disease. Trials 22, 252 (2021).Sohanpal R, et al. 'Tailored, psychological intervention for anxiety or depression in people with chronic obstructive pulmonary disease, TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD): protocol for a randomised controlled trial. Trials 21, 18 (2020)Trial registration: ISRCTN59537391