Most cancer patients may not receive adequate treatment for comorbid depression

1. The prevalence of major depression was highest in those with lung cancer, followed by gynecological, breast, colorectal, and genitourinary cancers.

2. Most of the cancer patients studied (73%) did not receive effective treatment for their depression.

Evidence Rating Level: 3 (Average)

Study Rundown: Major depression is commonly seen in patients with cancer. Since comorbid depression is associated with poor adherence to cancer treatments and an overall negative impact on quality of life, it is crucial to identify which patients are most at risk for becoming depressed. This study aimed to assess the prevalence of depression in various cancer types and the associations between depression and various demographic measures (e.g. gender, age). The investigators also sought to identify any treatments that cancer patients with major depression were receiving.

The results showed that the highest prevalence of major depression was seen in patients with lung cancer, followed by gynecological, breast, colorectal, and genitourinary cancers. Depression was also more prevalent in younger patients compared to older patients, in those with worse social deprivation scores, and was greater in females than males with lung and colorectal cancer. Additionally, nearly three-quarters of patients with depression were not receiving adequate treatment. Limitations of the study included that not all clinic patients were screened for depression and patients who scored below the depression scale cutoff were not further screened for depression. This study was strengthened by the large sample size, use of screening to obtain the sample population, and use of interviews to diagnose depression and establish treatments. The authors concluded that better approaches to treating comorbid depression in cancer patients could positively impact cancer survivability and further attention and screening of lung and gynecological cancer patients may be warranted.

This study was funded by Cancer Research UK and the Chief Scientist Office of the Scottish Government.

Click to read the study, published today in The Lancet Psychiatry

Relevant Reading: Evidence-based treatment of depression in patients with cancer

In-Depth [cross-sectional study]: This study analyzed data from 21,151 patients with breast, lung, colorectal, genitourinary, or gynecological cancer who attended an outpatient cancer clinic in Scotland between 2008 and 2011. To screen for depression in these patients, they employed a two-step approach. In the first step, patients were screened in the outpatient setting using the Hospital Anxiety and Depression Scale (HADS). Patients who scored 15 or higher were contacted at home and asked to complete a semi-structured clinical interview consisting of the Structured Clinical Interview for the DSM-IV (SCID) to determine if the patient met criteria for major depression. Those with adjustment disorder were ruled out by ensuring that the symptoms had persisted for at least 4 weeks. Patients with major depression were asked whether they had ever been prescribed any pharmacological or alternative therapeutic modalities or were regularly seeing a psychiatrist or psychologist.

5,510 (26%) of 21,151 patients had a HADS score of ≥15 and 4,365 (79%) of these patients completed a SCID interview. The prevalence of major depression was highest in patients with lung cancer (13.1%, 95% Confidence Interval [CI] 11.9-14.2%), followed by gynecological cancer (10.9%, 9.8-12.1%), breast cancer (9.3%, 8.7-10.0%), colorectal cancer (7.0%, 6.1-8.0%), and genitourinary cancer (5.6%, 4.5-6.7%). Additionally, 1,130 (73%) of 1,538 patients diagnosed with major depression at the interview were not receiving therapy that could effectively address their symptoms, and 340 (24%) were taking antidepressant drugs, while only 74 (5%) were visiting a mental health professional. 

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