Depression in Cancer Patients: What We Are Missing and What Can Be Done
Major depression is an important complication of cancer that can result in additional impairment of quality of life. A series of three articles published in the Lancet presented new research on depression in people with cancer and confirmed that depression is common, significantly undertreated, and can be improved once diagnosed and managed with an integrated treatment program, even in patients with major depression.
The first article reported the results attained from screening over 21,?000 patients with cancer in Scotland and the UK between 2008, and 2011. The prevalence of major depression was 13.1% in lung cancer, 10.9% in gynecological cancer, 9.3% in breast cancer, and 7.0% in colon cancer. Major depression was more likely in patients who were younger and had worse social deprivation scores. Moreover 73% of patients with depression were not receiving potentially effective treatment.
A new multicomponent collaborative approach, known as Depression Care for People with Cancer (DCPC), was evaluated in 2 clinical trials: the SMaRT-2 study, reported in the Lancet , and the SMaRT-3 study, reported in the Lancet Oncology. The integrated collaborative care model that was tested in these trials utilized a team of specially trained nurses, primary care doctors, and psychiatrists and demonstrated that this strategy can greatly improve outcomes for depressed patients with cancer compared with “usual care.”
The SMaRT-2 study compared the effectiveness of an integrated treatment program for major depression in 500outpatients with cancer to usual care by a primary care physician. Overall, 62% of participants receiving the integrated treatment program for depression responded to treatment compared to only 17% of those in the usual care group. Participants receiving the integrated care program also reported less depression, anxiety, pain, and fatigue. They also reported better functioning, health, quality of life, and perceived quality of depression care.
The SMaRT-3 study evaluated an integrated depression treatment program in lung cancer patients with major depression. The results from this study indicated that even major depression can be treated effectively in cancer patients with a poor prognosis.
Depression in cancer patients is under diagnosed and under treated. The results of these recent studies reflect the prevalence of depression among patients and demonstrates that the DCPC approach used in the SMaRT studies, combined with systematic screening, is one model of how to deliver better care for patients with cancer.
Many cancer centers in the United States have developed similar programs to the DCPC approach in the SMaRT studies for the diagnosis and management of depression in patients with cancer. In the past, many comprehensive cancer centers have provided an integrated approach to psychological support for their cancer patients, and they are all now required to offer these services to their patients. Find out if integrated approaches are available at your treatment center.
Virtual Support Groups: Anytime, Anywhere
Cancer patients count social and emotional support among the biggest benefits of social media. Virtual online support groups like CancerConnect offer patients, caregivers, friends, and family peer-to-peer support in a private, moderated and anonymous community accessible anytime, anywhere. “People with cancer and their caregivers need ongoing access to support—not just during a brief office visit with their physician, but when they go home and do research. They need help during sleepless nights as well as busy days,” explains Charles Weaver, MD, a medical oncologist and CEO of OMNI Health Media, the developer of CancerConnect.
 Walker J, Hansen C, Martin P, et al. Prevalence, associations and adequacy of treatment of major depression in 21?151 cancer outpatients: a cross-sectional analysis of routinely collected clinical data. The Lancet Psychiatry, Early Online Publication, 28 August 2014
 Sharpe M, Walker J, Hansen C, et al. Integrated collaborative care for comorbid major depression in cancer patients (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. The Lancet, Early Online Publication, 28 August 2014
 Walker J, Hansen C, Martin P, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled efficacy trial in patients with lung cancer.The Lancet Oncology, Early Online Publication, 28 August 2014
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