'Strikingly Effective' Approach for Depression
in Cancer Patients
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A new integrated program for treating depression in cancer patients is reported to be "strikingly more effective" at both reducing depressive symptoms and improving quality of life than the current standard of care. The new approach, known as Depression Care for People with Cancer (DCPC), was tested in 2 clinical trials: the SMaRT-2 study, reported in theLancet , 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 showed that this strategy can greatly improve outcomes for depressed patients with cancer compared with usual care, David Kissane, MD, head of psychiatry for Monash University, Victoria, Australia, writes in an accompanying commentary in the Lancet Psychiatry.
"The approach used in the SMaRT Oncology trials combined with systematic screening provides an outstanding model of how to begin to deliver this much-needed care for patients with cancer everywhere," he says.
The commentary accompanied a new analysis published in theLancet Psychiatry showing that the majority of cancer patients (73%) with depression are not getting any treatment for their depression, as reported by Medscape Medical News.
This finding comes from a study of 21,000 cancer patients using clinics in Scotland, which found that major depression is substantially more common in cancer patients than in the general population. These symptoms were most commonly observed in lung cancer patients (13%) and were the least common in genitourinary cancer patients (6%).
"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," Dr. Kissane noted.
New 'Strikingly Effective' Protocol
One of the clinical trials that tested the new DCPC protocol was the SMaRT Oncology-2 randomized trial, which found that at 6 months, significantly more of the patients who received DCPC responded to treatment (with at least a 50% reduction in the severity of their depression) compared with those who received usual care. The overall response to treatment was 62% with DCPC vs 17% with usual care (P < .001).
"The huge benefit that DCPC delivers for patients with cancer and depression shows what we can achieve for patients if we take as much care with the treatment of their depression as we do with the treatment of their cancer," lead author Michael Sharpe, MD, from the Department of Psychiatry, University of Oxford, United Kingdom, commented in a statement.
Dr. Sharpe and colleagues compared the effectiveness of the DCPC for major depression in cancer patients with usual care. The integrated program is delivered by a multidisciplinary group working in collaboration with the patient's cancer team and general practitioner. The program includes both pharmaceutical and psychological therapy.
The study included 500 adults with major depression as well as cancer who had a good prognosis (predicted survival of longer than 12 months). The patients were randomly assigned to receive either DCPC or usual care. Treatment for the usual-care group consisted of informing the patient's primary care physician and oncologist of the major depression diagnosis; they were then asked to treat the patient under normal protocol. In the United Kingdom, this might mean antidepressant drug therapy or a referral to mental health services, the authors note.
When compared with those in the usual-care group, participants in the DCPC arm had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all time points (all P < .05).
During the study period, there were 34 cancer-related deaths (19 in the DCPC group and 15 in the usual-care group). In addition, 1 patient was admitted to a psychiatric ward, and 1 attempted suicide. Although both were in the DCPC group, the events were not deemed to be related to the trial treatments or procedures.
Effective for Good- and Poor-Prognosis Patients
The other trial, SMaRT-3, evaluated a version of DCPC that was specifically adapted for patients with cancer who had a typically poor prognosis. For this study, lead author Jane Walker, MBChB, PhD, a consultant psychiatrist at the University of Oxford, and colleagues randomly assigned 142 patients with primary lung cancer and with a predicted survival of at least 3 months to DCPC (n = 68) or usual care (n = 72).
The DCPC arm and the usual-care arm followed protocols and care similar to those followed in the SMaRT Oncology-2 study. The primary outcome was depression severity (on the Symptom Checklist Depression Scale [SCL-20], range 0 - 4) averaged over the patient's time in the trial (up to a maximum of 32 weeks).
Of this group, 43 (30%) of the patients had died of cancer-related causes by 32 weeks. Outcome data were based on 131 (92%) of the cohort (59 in the group receiving depression care for people with lung cancer and 72 in the usual-care group).
The authors found that the average depression severity was significantly lower in the DCPC group (mean score on the SCL-20, 1.24 [SD, 0.64]) than in those who received usual care (mean score, 1.61 [SD, 0.58]; difference, -0·38). The self-rated depression improvement, anxiety, quality of life, role functioning, perceived quality of care, and proportion of patients achieving a 12-week treatment response were also significantly higher among patients in the DCPC group, compared with usual care.
"Patients with lung cancer often have a poor prognosis," said Dr. Walker in a release. "If they also have major depression, that can blight the time they have left to live. This trial shows that we can effectively treat depression in patients with poor-prognosis cancers like lung cancer and really improve patients' lives."
Both studies were funded by Cancer Research UK and Chief Scientist Office of the Scottish Government. None of the authors or the editorialist have reported any relevant financial relationships.
Lancet. Published online August 28, 2014. Abstract
Lancet Oncol. Published online August 28, 2014. Abstract
Lancet Psychiatry. Published online August 28, 2014. Commentary
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