Major Depression Is Undertreated in Patients With Cancer
In a Scottish study reported in The Lancet Psychiatry, Walker et al assessed the prevalence and adequacy of treatment of major depression in patients with cancer of different primary sites. The prevalence of major depression ranged from 5.6% in patients with genitourinary cancers to 13.1% in those with lung cancer. Approximately three-quarters of patients were not receiving potentially effective treatments for depression.
Study Details
The study involved analysis of data from patients with breast, lung, colorectal, genitourinary, or gynecologic cancers who had participated in routine screening for depression in cancer clinics in Scotland between May 2008 and August 2011. Depression screening was performed with the Hospital Anxiety and Depression Scale (HADS). Patients with a HADS score ≥ 15 were interviewed by telephone using the depression section of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID), to determine whether criteria for major depression were met. Data on depression status were linked with demographic and clinical data from the Scottish National Cancer Registry.
Prevalence
Among 21,151 patients included in the analysis, the prevalence of major depression was 13.1% (95% confidence interval [CI] = 11.9%–14.2%) in patients with lung cancer, 10.9% (95% CI = 9.8%-12.1%) in those with gynecologic cancer, 9.3% (95% CI = 8.7%–10.0%) in those with breast cancer, 7.0% (95% CI = 6.1%–8.0%) in those with colorectal cancer, and 5.6% (95% CI = 4.5%–6.7%) in those with genitourinary cancer.
Significantly (all P < .05) increased risk of depression were observed for women vs men with lung, genitourinary, and colorectal cancers (adjusted odds ratios [ORs] = 1.38–1.62), patients aged < 50 with all cancer types (OR ranges = 0.23–0.36 for age ≥ 70 years and 0.76–0.97 for age 50–59 years), and patients with increased social deprivation for all cancer types (ORs = 2.20–11.0 for lowest vs highest quintile of Scottish Index of Multiple Deprivation score).
Proportion Receiving Treatment
Among 1,538 patients with major depression and complete patient-reported treatment data, 73% were not receiving any treatment, 22% were receiving antidepressant medication alone, 3% were seeing a mental health professional alone, and 2% were both taking antidepressant medication and seeing a mental health professional. On adjusted analysis, women were more likely than men to receive potentially effective treatment (29% vs 18%, OR = 2.22, P = .0004), as were younger patients (35% of those aged < 50 years vs 31%, OR = 0.91, for 51–59 years; 25%, OR = 0.68, for 60–69 years; and 13%, OR = 0.33, for ≥ 70 years; P < .0001 for trend). Type of primary cancer was also significantly associated with receipt of therapy (P = .0048 for trend); compared with patients with colorectal cancer (25% receiving therapy), those with breast cancer (32%, OR = 0.93), lung cancer (19%, OR = 0.75), and gynecologic cancer (25%, OR = 0.68) were less likely to receive treatment and those with genitourinary cancer were more likely (30%, OR = 2.16).
The investigators concluded: “Major depression is common in patients attending cancer clinics and most goes untreated. A pressing need exists to improve the management of major depression for patients attending specialist cancer services.”
Jane Walker, PhD, of University of Oxford Department of Psychiatry, is the corresponding author for The Lancet Psychiatry article.
The study was funded by Cancer Research UK and the Chief Scientist Office of the Scottish Government. The study authors reported no potential conflicts of interest.
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