New program cuts depression in cancer patients
Thursday 3. July 2008
Last Updated: 2008-07-03 18:30:25 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A nurse-delivered intervention can improve depressive symptoms, anxiety, and fatigue in cancer patients with major depressive disorder, according to a report in the July 5th issue of The Lancet.
In the "Depression Care for People with Cancer" (DCPC) program, patients participate in one-to-one sessions with nurses who educate them about depression and its treatments and provide problem-solving training to help them learn to overcome their sense of helplessness. The progress of each session was reported by the nurse to patient's oncologist and primary-care doctor.
Depression is known to have a major adverse impact on the quality of life for patients with cancer and other serious diseases, yet the optimal treatment for this problem is unclear, Dr. Michael Sharpe, from the Royal Edinburgh Hospital in the UK, and colleagues note.
The Symptom Management Research Trials (SMaRT) oncology 1 study involved 200 patients with cancer and major depression who were expected to live at least 6 months. The subjects, who were 56.6 years of age on average and 71% female, were randomized to receive usual care alone or combined with DCPC for 3 months. Patients in the DCPC group were eligible to receive up to 10 one-on-one sessions.
Based on the Symptom Checklist-20 depression score, adding DCPC to usual care significantly reduced depressive symptoms. This effect was noted at 3 months and maintained at 6 and 12 months.
DCPC did not improve pain or physical functioning, but it was associated with a drop in anxiety and fatigue, the report indicates.
For each quality-adjusted life-year gained, DCPC cost $10,556, the authors calculate.
"In a well-designed study, (the researchers) 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," Dr. Gary Rodin, from University Health Network, Toronto, writes in an accompanying editorial.
Lancet 2008;372:8-10,40-48.