The study also found that major depression is substantially more common in cancer patients than in the general population.
The researchers, led by Jane Walker, MBChB, PhD, a consultant psychiatrist at the University of Oxford in the United Kingdom, analyzed data from 21,151 patients with breast, lung, colorectal, genitourinary, or gynecologic cancer who had participated in routine screening for depression at several cancer clinics in Scotland.
The prevalence of major depression was highest in patients with lung cancer (13.1%), followed by gynecologic cancer (10.9%), breast cancer (9.3%), colorectal cancer (7.0%), and genitourinary cancer (5.6%).
Overall, 73% of these patients were not receiving any treatment for depression.
“If unrecognized and untreated depression in patients with cancer shortens survival, harms quality of life, and increases risk for suicide, a compelling case emerges for using both screening and an integrated collaborative model of depression management,” writes David Kissane, MD, head of psychiatry for Monash University in Victoria, Australia, in an accompanying comment.
However, he points out that numerous barriers contribute to cancer patients not having their depressive symptoms recognized. These include lack of time, the normalization of distress, the attribution of somatic symptoms of depression to cancer, and the desire to avoid the social stigma that is still attached to mental illness.
But screening patients for depression is only of value if it leads to effective treatment,” says Dr. Kissane. “Knowledge of cost effectiveness will also help the case to address this need.”
He notes that in “keeping with the call” made by Dr. Walker and her colleagues, improved systematic care for patients with cancer and depression is urgently needed.
To address that need, Dr. Kissane points to an integrated collaborative care model, the Depression Care for People With Cancer approach, used in the SMaRT Oncology-2 (Lancet. Published online August 28, 2014) and SMaRT Oncology-3 (Lancet Oncol. Published online August 28, 2014) trials, which showed that a strategy of using specially trained nurses, primary care doctors, and psychiatrists can greatly improve outcomes for depressed patients with cancer, compared with usual care.
This approach, when combined with systematic screening, provides an “outstanding model of how to begin to deliver this much-needed care for patients with cancer everywhere,” he writes.
Depression is a common mood disorder observed in cancer patients, and can adversely affect outcomes. One meta-analysis found that depression is a small but significant predictor of mortality in cancer patients. In another study, psychiatric treatment and psychosocial support were shown to make a significant difference to survival and quality of life in women with metastatic breast cancer who exhibit symptoms of depression and anxiety.
The type of depression treatment also appears to be important. A previous study found that the collaborative Mood-Promoting Access to Collaborative Treatment (IMPACT) program had a better response rate in depressed cancer patients than usual care. Patients in the IMPACT group were twice as likely to respond to the depression treatment as those in the usual-care group (39% vs 20%; P = .029).
Majority of Patients Not Treated
In their current study, Dr. Walker and colleagues conducted depression screening in 2 stages: the Hospital Anxiety and Depression Scale was used first, followed by the major depression section of the Structured Clinical Interview for DSM-IV.
Aside from the differences in cancer types, the researchers found that a diagnosis of major depression was more likely in patients who were younger and who had worse social deprivation scores. For patients with lung cancer and colorectal cancer, depression was more prevalent in women.
Strikingly, of the 1538 patients with depression for whom complete patient-reported treatment data were available, 1130 (73%) were not receiving potentially effective treatment.
Less than a quarter (24%) of the patients were receiving an antidepressant at a minimal effective dose or higher, and very few (5%) were receiving any type of therapy from a mental health professional. The patients most likely to be getting any type of treatment tended to be younger and female, particularly those with breast cancer (32%). Conversely, lung cancer patients were the least likely (19%) to be receiving any treatment for their depression.
“These findings have several implications for clinical services,” conclude Dr. Walker and colleagues. “Major depression, although not ubiquitous among cancer outpatients, is common and therefore merits greater attention.”
“Furthermore, its greater prevalence in patients with some cancer groupings, notably lung cancer, suggests where screening for depression will find the most cases,” they add.
The study was funded by Cancer Research UK and the Chief Scientist Office of the Scottish Government. Dr. Walker and colleagues and Dr. Kissane have disclosed no relevant financial relationships.