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 The researchers also found that serious depression is more common
for cancer patients than for the general population, and varies by
type of cancer.
They also tested a new treatment program, with mental health care
integrated into cancer treatment, which was much more effective at
reducing depression and improving quality of life than current
treatments, they found.
Cancer doctors focus on the cancer, but depression deserves
attention and treatment too, said Dr. Michael Sharpe of
Psychological Medicine Research at the University of Oxford
Department of Psychiatry, who co-wrote all three papers.
He and his team analyzed data from more than 21,000 patients
attending outpatient cancer clinics in Scotland who had been
routinely screened for depression between 2008 and 2011.
Depression was most common in people with lung cancer, affecting 13
percent of patients, followed by gynecological, breast and
colorectal cancer and finally genitourinary cancer, for which six
percent of patients were diagnosed as depressed.
In the U.S. between 2007 and 2010, eight percent of people age
twelve and older had experienced depression symptoms in any two-week
period, according to the Centers for Disease Control and Prevention.
A depression diagnosis was more likely for patients who were
younger, and among those with lung or colorectal cancer, women.
Nearly three quarters of depressed cancer patients were not
receiving treatment for depression, according to results in The
Lancet Psychiatry.
Twenty-four percent were taking antidepressants and five percent
were seeing a mental health professional, with a few doing both.
The researchers tested a new treatment program called 'Depression
Care for People with Cancer' (DCPC) on 500 adults with clinical
depression and a cancer with a good prognosis. The program requires
a team of specially trained cancer nurses and psychiatrists. Working
in collaboration with the patient's cancer team and general
practitioner, they screen for depression and try different
treatments, including antidepressants and therapy.
After six months, the severity of depression was reduced by at least
half in 62 percent of patients who had mental health care integrated
into cancer treatment, compared with 17 percent of patients who
received their usual care, according to results in The Lancet.
“For the ones that were randomized to usual care, we made sure the
patient understood that they had major depression, wrote to (the)
primary care doctor to tell them that they had major depression, but
the outcome was terrible,” Sharpe told Reuters Health by phone.
The researchers estimate DPCP would cost about $1,000 per patient.
“We made sure they did actually get and use antidepressants and
psychological treatment,” Sharpe said.
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With cancer nurses continuing to see patients in a proactive way, if
depression wasn’t improving, the treatment was continually changed,
he said.
Satisfied that the program would work well for people with good
cancer prognoses, the researchers also tried a modified version for
people with lung cancer, which typically has a poor prognosis, and
found similarly successful results, as they reported in The Lancet
Oncology.
Both versions of DCPC improved anxiety, functioning and quality of
life as well as depression symptoms.
“Our patients got psychological treatment which despite being
theoretically available really wasn’t used,” Sharpe said. “They are
all off the shelf treatments we used, nothing is new but the way
they were packaged.”
This should also be the approach for depression generally, but
cancer patients in particular are already attending the hospital
regularly, he said.
Kathleen Ell, a professor at the University of Southern California
School of Social Work who studies depression alongside cancer and
diabetes in a “safety net” population, told Reuters Health that
these are important manuscripts that will influence cancer care
research in the U.S.
Some cancer patients may not want to take more pills than they
already have to, but psychotherapy can be quite effective in only
six to ten sessions with a therapist, she told Reuters Health by
phone.
The trouble with implementing a program like DCPC more widely is a
lack of resources and roadmaps, experts agreed.
“We have lots of documents in the U.K. and U.S. saying we need to
integrate this care but very little info on how we should do it,”
Sharpe said. “People think if we have the mental health clinic next
door to the cancer clinic that’ll do it.”
SOURCES: The Lancet, The Lancet Psychiatry, and The Lancet Oncology
http://bit.ly/1qtnR9t, http://bit.ly/WkU6v9, and http://bit.ly/1qtnVpA
August 28, 2014.
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