Integrative Psychiatry Effective but Overlooked for Cancer Patients

Three papers published in The Lancet Psychiatry, The Lancet, and The Lancet Oncology  reveal that around three-quarters of cancer patients who have major depression are not currently receiving treatment for depression, and that a new integrated treatment program is strikingly more effective at reducing depression and improving quality of life than current care.

Nurse Giving Patient InjectionAn analysis of data from more than 21 000 patients attending cancer clinics in Scotland, UK, published in The Lancet Psychiatry, found that major depression is substantially more common in cancer patients than in the general population. Major depression was most common in patients with lung cancer (13%) and lowest in those with genitourinary cancer (6%). Moreover, nearly three quarters (73%) of depressed cancer patients were not receiving treatment.

To address the problem of inadequate treatment the SMaRT Oncology-2 randomised trial, published in The Lancet, evaluated the effectiveness of a new treatment programme called ‘Depression Care for People with Cancer’ (DCPC). DCPC is delivered by a team of specially trained cancer nurses and psychiatrists, working in collaboration with the patient’s cancer team and general practitioner, and is given as part of cancer care.  It is a systematic treatment programe that includes both antidepressants and psychological therapy.

The trial, involving 500 adults with major depression and a cancer with a good prognosis (predicted survival more than 12 months) compared DCPC with usual care. DCPC was strikingly more effective at reducing depression. At 6 months, 62% of the patients who received DCPC responded to treatment (at least a 50% reduction in the severity of their depression) compared with only 17% of those who received usual care. This benefit was sustained at 12 months. DCPC also improved anxiety, pain, fatigue, functioning, and overall quality of life. Moreover, the cost of providing DCPC was modest (£613 per patient) making it a cost-effective way to improve cancer patients’ quality of life.

Findings: The study analysed data for 21 151 patients. The prevalence of major depression was highest in patients with lung cancer (13·1%, 95% CI 11·9–14·2%), followed by gynaecological 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). Within these cancer groupings, a diagnosis of major depression was more likely in patients who were younger, had worse social deprivation scores, and, for lung cancer and colorectal cancer, female patients. 1130 (73%) of 1538 patients with depression and complete patient-reported treatment data were not receiving potentially effective treatment.

According to lead author Professor Michael Sharpe from the University of Oxford in the UK, “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.”

To see if patients with a poor prognosis cancer could also benefit from this approach, the SMaRT Oncology-3 randomised trial, published in The Lancet Oncology, tested a version of DCPC adapted for patients with a typically poor prognosis cancer (lung cancer).  The trial, involving 142 patients with lung cancer and major depression, found that those who received the lung cancer version of DCPC had a significantly greater improvement in depression than those who received usual care during 32 weeks of follow-up. The lung cancer-specific version of DCPC also improved anxiety, functioning, and quality of life.

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 really improve patients’ lives.”