DEPRESSION

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Just Published from The Lancet

Tackling major depression in patients with cancer

• 02 Sep 14

Specialists compare the outcomes of depression care and usual care in outpatients at cancer centres

Background

Medical conditions are often complicated by major depression, with consequent additional impairment of quality of life. We aimed to compare the effectiveness of an integrated treatment programme for major depression in patients with cancer (depression care for people with cancer) with usual care.

Methods

SMaRT Oncology-2 is a parallel-group, multicentre, randomised controlled effectiveness trial. We enrolled outpatients with major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with cancer intervention or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. Depression care for people with cancer is a manualised, multicomponent collaborative care treatment that is delivered systematically by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. Outcome data were collected up until 48 weeks. The primary outcome was treatment response (≥50% reduction in Symptom Checklist Depression Scale [SCL-20] score, range 0—4) at 24 weeks. Trial statisticians and data collection staff were masked to treatment allocation, but participants could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN40568538.

Findings

500 participants were enrolled between May 12, 2008, and May 13, 2011; 253 were randomly allocated to depression care for people with cancer and 247 to usual care. 143 (62%) of 231 participants in the depression care for people with cancer group and 40 (17%) of 231 in the usual care group responded to treatment: absolute difference 45% (95% CI 37—53), adjusted odds ratio 8·5 (95% CI 5·5—13·4), p<0·0001. Compared with patients in the usual care group, participants allocated to the depression care for people with cancer programme also had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all timepoints (all p<0·05). During the study, 34 cancer-related deaths occurred (19 in the depression care for people with cancer group, 15 in the usual care group), one patient in the depression care for people with cancer group was admitted to a psychiatric ward, and one patient in this group attempted suicide. None of these events were judged to be related to the trial treatments or procedures.

Interpretation

Our findings suggest that depression care for people with cancer is an effective treatment for major depression in patients with cancer. It offers a model for the treatment of depression comorbid with other medical conditions.

References

Sharpe M, Walker J, Hansen CH, et al. 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.

Disclaimer

© 2014 Elsevier Ltd. All rights reserved. This journal and the individual contributions contained in it are protected under copyright by Elsevier Ltd, and the following terms and conditions apply to their use. The Lancet® is a registered trademark of Elsevier Properties S.A., used under licence. No responsibility is assumed by Elsevier for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.

The translation has been undertaken by Transperfect at its sole responsibility. No responsibility is assumed by Elsevier in relation to the translation or for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.

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2 Replies

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  • Gutless Wonder, you are my hero and I tell people about you all the time! I had my port out yesterday and my last Herceptin appointment a week ago and I shared with my oncologist a bit of depression which I am taking meds for and even with that I still try to figure out where I go from here! Knowing that I have limitations e.g. neuropathy taking gabapentin. Both my husband and I own our on business and am very grateful that we did not have to sell our bed and breakfast because of my health and had a previous staff member come back as a manager as we do not live on the property! My husband is a general contractor, fire sprinkler contractor & plumbing contractor with employees also and he has a office at the Inn and did double time for the last year! I had to let go of control and for type A personality is quite difficult but for me is a blessing in disguise I believe for both my husband and I have learned that we are not all that nor do we have to be! Thats where the depression can set in. We have a therapist with a PH.D her husband went through cancer. It really helps if one has a someone to talk to that can give you direction. I am grateful that through this journey we have had this therapist as my former therapist Dr. Fong got a cancer diagnosis 4 months before mine and referred us to a new therapist as she has since retired! Mental health is as important as physical health as both the therapist helps my husband and I with business, personal & family. It does not mean that we are warped. Well yes, I am surely warped when it comes to a sense of humor as you too must be by your title of gutless wonder! Which I love about you. Just stating that everyone can use an objective ear or two that will listen to us and give us objective direction! Two ears no waiting.Thank you for sharing all you have as you are my hero!!!!!

  • Mind over matter !

    You sound terrifically positive and upbeat.Our path is a saw tooth - zig up one day then zag a bit down the next but the overall trend is rising.

    To keep myself cheerful I am reading for a degree in medicine -my specialty will be cliches.

    I have always fancied having a sprinkler fitted, what part of the country does your husband cover ?