By Kathryn Doyle
NEW YORK - Three new studies by researchers at the Universities of Oxford and Edinburgh in the U.K. reveal that three-quarters of depressed cancer patients are not receiving treatment for depression.
The researchers also found that serious depression is more common for cancer patients than for the general population, and varies by type of cancer.
They also tested a new treatment program, with mental health care integrated into cancer treatment, which was much more effective at reducing depression and improving quality of life than current treatments, they found.
Cancer doctors focus on the cancer, but depression deserves attention and treatment too, said Dr. Michael Sharpe of Psychological Medicine Research at the University of Oxford Department of Psychiatry, who co-wrote all three papers.
He and his team analyzed data from more than 21,000 patients attending outpatient cancer clinics in Scotland who had been routinely screened for depression between 2008 and 2011.
Depression was most common in people with lung cancer, affecting 13% of patients, followed by gynecological, breast and colorectal cancer and finally genitourinary cancer, for which 6%of patients were diagnosed as depressed.
In the U.S. between 2007 and 2010, 8% of people age twelve and older had experienced depression symptoms in any two-week period, according to the Centers for Disease Control and Prevention.
A depression diagnosis was more likely for patients who were younger, and among those with lung or colorectal cancer, women.
Nearly three quarters of depressed cancer patients were not receiving treatment for depression, according to results in The Lancet Psychiatry.
Twenty-four percent were taking antidepressants and 5% were seeing a mental health professional, with a few doing both.
The researchers tested a new treatment program called 'Depression Care for People with Cancer' (DCPC) on 500 adults with clinical depression and a cancer with a good prognosis. The program requires a team of specially trained cancer nurses and psychiatrists. Working in collaboration with the patient's cancer team and general practitioner, they screen for depression and try different treatments, including antidepressants and therapy.
After six months, the severity of depression was reduced by at least half in 62% of patients who had mental health care integrated into cancer treatment, compared with 17% of patients who received their usual care, according to results in The Lancet.
"For the ones that were randomized to usual care, we made sure the patient understood that they had major depression, wrote to (the) primary care doctor to tell them that they had major depression, but the outcome was terrible," Sharpe told Reuters Health by phone.
The researchers estimate DPCP would cost about $1,000 per patient.
"We made sure they did actually get and use antidepressants and psychological treatment," Sharpe said.
With cancer nurses continuing to see patients in a proactive way, if depression wasn't improving, the treatment was continually changed, he said.
Satisfied that the program would work well for people with good cancer prognoses, the researchers also tried a modified version for people with lung cancer, which typically has a poor prognosis, and found similarly successful results, as they reported in The Lancet Oncology.
Both versions of DCPC improved anxiety, functioning and quality of life as well as depression symptoms.
"Our patients got psychological treatment which despite being theoretically available really wasn't used," Sharpe said. "They are all off the shelf treatments we used, nothing is new but the way they were packaged."
This should also be the approach for depression generally, but cancer patients in particular are already attending the hospital regularly, he said.
Kathleen Ell, a professor at the University of Southern California School of Social Work who studies depression alongside cancer and diabetes in a "safety net" population, told Reuters Health that these are important manuscripts that will influence cancer care research in the U.S.
Some cancer patients may not want to take more pills than they already have to, but psychotherapy can be quite effective in only six to ten sessions with a therapist, she told Reuters Health by phone.
The trouble with implementing a program like DCPC more widely is a lack of resources and roadmaps, experts agreed.
"We have lots of documents in the U.K. and U.S. saying we need to integrate this care but very little info on how we should do it," Sharpe said. "People think if we have the mental health clinic next door to the cancer clinic that'll do it."
The Lancet, The Lancet Psychiatry, and The Lancet Oncology, 2014.
(c) Copyright Thomson Reuters 2014.