Repetitive Transcranial Magnetic Stimulation in Cancer Patients With Depression and Anxiety (rTMSinCP)

November 15, 2023 updated by: Mehmet Dokucu, Northwestern University

A Randomized Open-Label Pilot Trial To Evaluate The Safety And Efficacy Of Repetitive Transcranial Magnetic Stimulation In Cancer Patients With Depression And Anxiety

Cancer is a leading cause of mortality and morbidity worldwide. In addition, cancer is associated with high rates of depression and anxiety among its sufferers, and cancer patients with depression usually have worse treatment outcomes and long-term survival. Surprisingly, many cancer patients with depression do not receive treatment for their depression, perhaps because treatments for cancer-related depression are usually adapted from those used in non-cancer populations and may not be suitable for cancer patients. Moreover, cancer patients with depression are more likely to have a long latency of anti-depressant drug action, negative drug-drug interactions with cancer chemotherapies and an increased susceptibility for systemic side effects. Repetitive transcranial magnetic stimulation (rTMS) is a new treatment modality for depression that affects the brain directly with no systemic side effects and poses no potential for drug-drug interactions. rTMS therapy was recently cleared by the FDA as an antidepressant treatment for treatment-resistant Major Depressive Disorder, and now is being evaluated for a wide array of additional psychiatric indications. This randomized, open label, two-arm, pilot study will investigate the safety, tolerability, feasibility and the efficacy of two forms of rTMS (i.e., left (fast) and right (slow) sided rTMS) in cancer-related depression. The study hypotheses are that rTMS will significantly reduce symptoms of depression and that right-sided slow rTMS will be more effective than left-sided fast rTMS for the treatment of severe anxiety.

Study Overview

Study Type

Interventional

Enrollment (Actual)

20

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Illinois
      • Chicago, Illinois, United States, 60611
        • Northwestern University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

22 years to 80 years (Adult, Older Adult)

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Female
  • Age 22-80
  • Had a previous diagnosis of cancer (any type or stage) confirmed by official medical records
  • Has a DSM IV diagnosis of Major Depressive Disorder
  • Has a HAM-D 24-item score of more than 20
  • Failed to receive satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current depressive episode
  • All participants must have given signed, informed consent prior to registration in study

Exclusion Criteria:

  • Participant had breast cancer with brain metastases
  • There is evidence of the disease at the time of entry into the trial
  • Presence or recent history of other concurrent cancers, with the following exceptions:

    • Participants with completely treated basal or squamous skin cancers can be included in the study if their physicians deem that they are medically stable
    • Participants with completely treated in situ carcinoma of the breast or cervix may be included in the study if they have not had chemotherapy within the past month and their physicians deem that they are medically stable
    • Participants with pre-cancerous lesions in the colon can be included in the study if they have not had chemotherapy within the past month and their physicians deem that they are medically stable
  • Participant had recent surgery (within two weeks)
  • Participant is undergoing chemotherapy
  • Participant is pregnant or nursing
  • Participant has any metallic object in or around their head
  • Participant has a pacemaker
  • Has unstable suicidal ideation as determined by the patient's treating psychiatrist
  • Substance use disorder within the prior six months
  • Significant history of head injury/trauma as defined by loss of consciousness for more than 1 hour
  • Recurring seizures resulting from the head injury
  • Clear cognitive sequelae from the head injury and cognitive rehabilitation following the injury
  • Any disorder that would predispose the participant to seizures
  • Use of concomitant medications that substantially increase seizure risk. Such drugs could include neuroleptics (ex. haloperidol, droperidol), clozapine, tricyclic antidepressants (ex. amoxapine, clomipramine), bupropion (particularly the immediate release - IR - formulation) donepezil, psychostimulants (ex. methylphenidate), theophylline and/or other drugs that reduce the seizure threshold. For individuals on any of these medicines, a study clinician will evaluate the drugs and doses to determine the risks and benefits. These will then be discussed with the individual's Primary Care Physician to determine if the individual should be excluded from the study.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Right-Sided Low-Frequency rTMS
Participants will have rTMS administered at 1Hz to the right dorsolateral Prefrontal Cortex (dlPFC) once a day for 40 minutes, 5 days a week, for a total of six weeks.
Other Names:
  • Neurostar TMS Therapy(R) System
Experimental: Left-Sided High-Frequency rTMS
Participants will have rTMS administered at 10Hz to the left dorsolateral Prefrontal Cortex (dlPFC) once a day for 40 minutes, 5 days a week, for a total of six weeks.
Other Names:
  • Neurostar TMS Therapy(R) System

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall change in depression severity
Time Frame: 0, 2, 4, and 6 weeks
Overall change in depression severity (as measured by the Hamilton Depression Rating Scale) will be measured for each treatment arm.
0, 2, 4, and 6 weeks
Relative change in depression severity
Time Frame: 0, 2, 4, and 6 weeks
Change in depression severity (as measured by the Hamilton Depression Rating Scale) for a treatment arm will be compared relative to change in depression severity in the other treatment arm.
0, 2, 4, and 6 weeks
Presence and changes in severity of side effects
Time Frame: 0, 2, 4, and 6 weeks
At weeks 2, 4 and 6, UKU Side Effects Rating Scale scores will be compared to baseline UKU scores to determine changes in presence and severity of side effects. Additionally, UKU scores at weeks 2, 4, and 6 will be used to determine probability that side effects are related to intervention.
0, 2, 4, and 6 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Overall change in anxiety severity
Time Frame: Weekly (starting with week 0 through week 6)
Overall change in anxiety severity (as measured by the Hamilton Anxiety Rating Scale) will be measured for each treatment arm.
Weekly (starting with week 0 through week 6)
Relative change in anxiety severity
Time Frame: Weekly (starting with week 0 through week 6)
Change in anxiety severity (as measured by the Hamilton Anxiety Rating Scale) for a treatment arm will be compared relative to change in anxiety severity in the other treatment arm.
Weekly (starting with week 0 through week 6)
Correlation of anxiety with change in depression severity
Time Frame: 0 and 6 weeks
Baseline anxiety severity (as measured by the Hamilton Anxiety Rating Scale) will be correlated with change (from baseline to end of week 6) in depression severity (as measured by the Hamilton Depression Rating Scale) for each treatment arm and compared.
0 and 6 weeks
Correlation of anxiety with harm avoidance personality trait
Time Frame: Baseline
Baseline anxiety severity (as measured by the Hamilton Anxiety Rating Scale) will be correlated with Harm Avoidance scores from the TCI personality inventory
Baseline

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Collaborators

Investigators

  • Principal Investigator: Mehmet Dokucu, MD, PhD, Northwestern University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

December 1, 2012

Primary Completion (Actual)

May 1, 2023

Study Completion (Actual)

May 1, 2023

Study Registration Dates

First Submitted

October 3, 2012

First Submitted That Met QC Criteria

October 3, 2012

First Posted (Estimated)

October 5, 2012

Study Record Updates

Last Update Posted (Estimated)

November 17, 2023

Last Update Submitted That Met QC Criteria

November 15, 2023

Last Verified

November 1, 2023

More Information

Terms related to this study

Other Study ID Numbers

  • NU 12CC12
  • NCI-2012-01691 (Registry Identifier: NCI Clinical Trials Reporting Program (CTRP))

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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