A cancer diagnosis can significantly alter one’s life and is a source of considerable psychological and emotional stress. General sadness may be a normal response to a cancer diagnosis, however, stress beyond the coping mechanisms of patients may result in major depressive disorder. Three papers reveal that around three-quarters of cancer patients who have major depression are not currently receiving treatment for depression. A new integrated treatment program is strikingly more effective at reducing depression and improving quality of life than current care.
Major depression is far more common in cancer patients than in the general population, according to a study published in The Lancet Psychiatry that examined data from over 21,000 patients attending cancer clinics in Scotland, UK.
Patients with lung cancer had the highest rate of major depression (13%) and the lowest rate (6%), among those with genitourinary cancer patients. Furthermore, 73% of cancer patients who were depressed did not receive treatment.
The SMaRT Oncology-2 randomized trial, published in The Lancet, assessed the efficacy of a novel treatment program named ‘Depression Care for People with Cancer’ (DCPC) to tackle the issue of insufficient treatment. As part of cancer care, DCPC is administered by a group of specially trained cancer nurses and psychiatrists who collaborate with the patient’s cancer team and general practitioner.
Treatment program that includes both antidepressants and psychological therapy
‘Depression Care for People with Cancer’ (DCPC) is a systematic treatment plan that combines psychological counselling with medications.
The trial compared DCPC with standard therapy in 500 persons with serious depression and cancer who had an excellent prognosis (predicted survival of more than 12 months) [1]. DCPC significantly outperformed other methods in lowering depression.
Compared to only 17% of patients receiving conventional care, 62% of patients who received DCPC responded to treatment at 6 months, meaning that their depression had at least 50% less intensity.
‘Depression Care for People with Cancer’ improved overall quality of life
At the 12-month mark, this benefit persisted. Additionally, DCPC enhanced general quality of life, functioning, discomfort, anxiety, and weariness.
Furthermore, DCPC was inexpensive (£613 per patient), making it a financially sensible approach to enhance the quality of life for cancer patients.
Lead author Professor Michael Sharpe of the University of Oxford in the United Kingdom claims that “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.”
The new treatment module can effectively treat depression and improve patients’ lives
In the SMaRT Oncology-3 randomized trial, published in The Lancet Oncology, a variant of DCPC tailored for patients with a normally poor prognosis malignancy (lung cancer) was examined to see if individuals with a poor prognosis could also benefit from this technique. During a 32-week follow-up period, the lung cancer version of DCPC significantly improved depression in 142 patients with serious depression who were part of the experiment. This was in comparison to patients who got conventional therapy. Anxiety, functionality, and quality of life were all enhanced by the DCPC variant designed specifically for lung cancer.
According to study leader Dr Jane Walker from the University of Oxford and Sobell House Hospice in Oxford in the UK, “Patients with lung cancer often have a poor prognosis. 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 improve patients’ lives.”
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Materials provided by The Lancet. Note: Content may be edited for style and length.
Journal References:
Michael Sharpe et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. The Lancet Psychiatry, August 2014 DOI: 10.1016/S2215-0366(14)70313-X
Michael Sharpe, Jane Walker, Christian Holm Hansen, Paul Martin, Stefan Symeonides, Charlie Gourley, Lucy Wall, David Weller, Gordon Murray. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. The Lancet, 2014; DOI: 10.1016/S0140-6736(14)61231-9
Jane Walker, Christian Holm Hansen, Paul Martin, Stefan Symeonides, Charlie Gourley, Lucy Wall, David Weller, Gordon Murray, Michael Sharpe. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. The Lancet Oncology, 2014; DOI: 10.1016/S1470-2045(14)70343-2
Page citation:
The Lancet. “Three-quarters of depressed cancer patients do not receive treatment for depression; new approach could transform care.” ScienceDaily. ScienceDaily, 27 August 2014. <www.sciencedaily.com/releases/2014/08/140827203635.htm>.
Toll-Free Mental Health Rehabilitation Helpline Kiran (1800-599-0019)
Name of the Organisation: Indian Cancer Society
The ICS is one of the first voluntary, non-profit, National Organization for Awareness, Detection, Cure, and Survivorship of those affected by this disease.
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Name of the Organisation: Vandrevala Foundation
Vandrevala Foundation is a non-profit that partners with organizations to help communities thrive by providing education and healthcare. Vandrevala Foundation launched a mental health helpline in India in 2009 to offer free psychological counselling and crisis mediation to anyone experiencing distress due to depression, trauma, mood disorders, chronic illness, and relationship conflict.
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