New approach could transform treatment of depression in cancer patients

Around three-quarters of cancer patients who have major depression do not currently receive treatment for their depression, new research led by Oxford University has found. But the researchers show that a new treatment programme is strikingly more effective at reducing depression and improving quality of life among cancer patients than current care.

The team analysed data from more than 21,000 patients attending cancer clinics in Scotland and 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 for their depression.

To address the problem of inadequate treatment, the researchers evaluated the effectiveness of a new treatment programme called ‘Depression Care for People with Cancer’ (DCPC) in a randomised trial called SMaRT Oncology-2.

The DCPC treatment programme 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 programme that includes both antidepressants and psychological therapy.

The trial involved 500 adults with major depression and a cancer with a good prognosis (they had a predicted survival of more than 12 months), and compared DCPC with usual care.

The researchers found that the Depression Care for People with Cancer programme was strikingly more effective at reducing depression.

Professor Michael Sharpe from the Department of Psychiatry at the University of Oxford said: ‘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.’

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 (