An article published in The Lancet finds that cancer patients who received a
care package called "Depression Care for People with Cancer" (DCPC) had
lower levels of depression than those who received the usual care
(antidepressants and mental health services recommended by the cancer team).
Professor Michael Sharpe (University of Edinburgh, UK) and other colleagues
who study psychological medicine also found that as a way of improving the
quality of life of cancer patients, DCPC is more cost-effective than the
current cancer treatments.
It is not uncommon for patients suffering from disorders such as cancer to
experience major depression - a condition that sharply reduces quality of
life. The medical community, however, lacks substantial research that can
assist physicians in helping patients manage depression. In order to add to
this scarce body of evidence, Sharpe and colleagues conducted the SMaRT
(Symptoms Management Research Trials) oncology 1 trial to study this new
complex care package (DCPC) specially designed for cancer patients with
depression and delivered by nurses.
Funded by Cancer Research UK, the trial consisted of 200 patients - all with
a cancer prognosis of more than six months and major depression - selected
from a regional cancer center in Scotland. The patients were about 56.6
years, on average, and 71% were women (141 of 200). In the randomization
process, 99 patients were placed in a group that received the usual care of
antidepressants and mental health referrals that depressed cancer patients
receive from their general practitioner and cancer team. The other 101
patients were placed in a group that received the usual care in addition to
DCPC.
The DPCP consisted of about seven one-on-one counseling sessions (over three
months) with a trained cancer nurse. In these sessions, the nurses provided
information about depression and ways to treat it (such as information on
the various antidepressant medications). As a method of preventing feelings
of helplessness among cancer patients, the nurses also offered
problem-solving treatment. Not only did the nurses remain in contact with
each patient's oncologist and primary-care doctor to discuss depression
management, but they also monitored progress via telephone after the
sessions were completed. If necessary, nurses would meet with patients for
optional additional sessions. The researchers used two methods to measure
depression in both groups: 1) the self-reported Symptom Checklist-20
depression scale, range 0 to 4, and 2) interviews after three, six, and 12
months.
Sharpe and colleagues found that patients who received DCPC had a lower
depression level - by 0.34 on the scale - than those who did not receive
DCPC. The treatment group also had a major depression rate that was 23%
lower than in the usual care group. After 12 months, the benefits from the
DCPC intervention were still evident. Although the DCPC did not reduce pain
or improve physical functioning, it did help patients who were suffering
from anxiety and fatigue.
The researchers claim that DCPC is potentially cost-effective. Studying the
numbers, the researchers report that the per patient cost of DCPC over six
months is £336 (US$668), which can be expanded to £5278 per quality-adjusted
life-year gained. This figure can be compared to the median level of cost
per quality-adjusted life-year gained of about £10,000 (US$20,000) for
anti-cancer treatments in general.
"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," conclude the authors.
An accompanying Comment, written by Professor Gary Rodin (Princess Margaret
Hospital, University Health Network, Toronto, ON, Canada), notes that, "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."
Source : Medical News Today
