A new care package -- ‘Depression Care for People with Cancer' (DCPC) -- can reduce levels of depression in cancer patients and is cost-effective in improving cancer patients' quality of life when compared with current cancer treatments. These are the conclusions of authors of an Article in this week's edition of The Lancet.
Major depression severely reduces the quality of life for many patients with medical disorders such as cancer, but evidence to guide its management is scarce. Professor Michael Sharpe, and colleagues in psychological medicine research at the University of Edinburgh, UK, assessed the efficacy and cost of a new nurse-delivered complex care package designed for cancer patients with depression in the SMaRT* oncology 1 trial.
The randomised trial, funded by Cancer Research UK, recruited 200 patients at a regional cancer centre in Scotland. All patients had a cancer prognosis of greater than six months, and major depression. Their mean age was 56.6 years, and 141 (71%) were women. 99 patients were randomised to received the usual care** that depressed cancer patients get from their general practitioner and cancer team, and 101 to have this supplemented with DCPC. Patients given DCPC were offered an average of seven one-to-one sessions over three months with a specially-trained cancer nurse. The sessions aimed to help patients to understand depression and its treatments, including antidepressants and provided problem-solving treatment to help patients overcome feelings of helplessness. The nurse also communicated with each patient's oncologist and primary-care doctor about the management of their depression. After completing initial treatment the nurse monitored the patients progress by telephone and provided optional booster sessions if needed. The patients' depression level was measured using the self-reported Symptom Checklist-20 depression scale (range 0 to 4) and also by interview at three, six, and 12 months in both groups.
The researchers found that for patients receiving DCPC, depression levels were lower (difference of 0.34 on the scale). The proportion of patients with major depression was 23% lower in the DCPC group, and the benefits of the intervention on depression were still evident at 12 months. The DCPC intervention also improved anxiety and fatigue, but did not improve pain or physical functioning. DCPC cost £336 (US$668) per patient over six months, equivalent to £5278 per quality-adjusted life-year gained. The median level of cost per quality-adjusted life-year gained is around £10000 (US$20000) for anti-cancer treatments -- thus making the Depression Care for People with Cancer package potentially cost-effective.
The authors conclude: "The intervention -- Depression Care for People with Cancer -- offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending special medical services that is feasible, acceptable, and potentially cost effective."
They add: "Ten per cent of cancer patients experience clinical depression and, unfortunately, it is not always adequately treated. This new treatment could substantially improve the way we manage depression in people with cancer and also in people with other serious medical conditions."***
In an accompanying Comment, Professor Gary Rodin, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada says: "In a well-designed study, Sharpe and colleagues have shown that trained nurses with no previous psychiatric experience can deliver a cost-effective collaborative psychosocial intervention for cancer patients with major depressive disorder. Such multicomponent interventions are potentially feasible in cancer treatment centres and can be perceived by patients as less stigmatising than referral to a mental health specialist."
Notes to editors:
*SMaRT - symptoms management research trials
**In usual care, a patient's GP and cancer team can may prescribe antidepressants of refer for counselling or to mental health services
***A verbal quote direct from authors and cannot be found in the text of the Article
For Professor Michael Sharpe, University of Edinburgh, UK, please contact Sally Staples, Cancer Research UK Press Office T) +44 (0) 20 7061 8313 E) Michael.sharpe@ed.ac.uk / Sally.Staples@cancer.org.uk
Professor Gary Rodin, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada T) +1 416-624-4573 / +1 416-946-4504 E) gary.rodin@uhn.on.ca
http://multimedia.thelancet.com/pdf/press/depression.pdf
Journal
The Lancet