Depression is Common, Treatable Among Cancer Patients

Multicomponent, collaborative care combats the depression frequently experienced by cancer patients

medwireNews: Depression is common among patients with cancer and can be alleviated with focused care but many patients remain undertreated, highlights a series of articles on the comorbidity that are published in The Lancet journals.

The results of routine depression screening of 21,151 patients in Scotland with common cancers between 2008 and 2011 are reported by Jane Walker, from the University of Oxford in the UK, and co-workers in The Lancet Psychiatry.

The prevalence of major depression ranged from 5.6% of patients with genitourinary cancer to 7.0% of colorectal cancer patients, 9.3% of breast cancer patients, 10.9% of gynaecological cancer patients and 13.1% of patients with lung cancer.

Finding that 73% of 1538 patients diagnosed with major depression were not receiving potentially effective treatment, such as an adequate antidepressant dose, the researchers emphasise that “[a] pressing need exists to improve the management of major depression for patients attending specialist cancer services.”

The results of SMaRT Oncology-2 and SMaRT Oncology-3 clinical trials of integrated collaborative care for comorbid major depression in cancer patients with good and poor prognoses are also reported at the same time in The Lancet and The Lancet Oncology, respectively.

For patients with a cancer prognosis of at least 12 months’ survival, the SMaRT Oncology-2 trial demonstrated that multicomponent care delivered by a team of cancer nurses, psychiatrists and primary care physicians offered a significantly better outcome for depression than usual care by primary care physicians alone.

Overall, 62% of the 231 patients given collaborative care responded to depression treatment compared with just 17% of 231 controls, giving an absolute difference of 45%, a significant adjusted odds ratio of 8.5 and a number needed to treat of 2.24.

Indeed, collaborative care was associated with less depression, anxiety, pain and fatigue, as well as better overall health, quality of life and functioning. And after 12 weeks, 72% of patients receiving collaborative care perceived their depression care as excellent or very good compared with just 25% of usual care patients.

“The most important implication of this study is that paying the same systematic attention to the management of comorbid major depression as we presently do to the associated medical condition achieves much better outcomes for patients”, write Michael Sharpe, from the University of Oxford, and co-authors.

The SMaRT Oncology-3 trial again demonstrated the greater efficacy of collaborative care for depression compared with usual care, this time in patients with lung cancer and an estimated survival of 3 months or more.

On average, depression was significantly less severe in 59 patients after undergoing collaborative care compared with 72 patients who received usual care, with a standardised mean difference of -0.62 on the Symptom Checklist Depression Scale.

Participants who were randomly assigned to receive collaborative care also reported less anxiety and depression alongside improved quality of life and functioning than those given usual care, add the researchers again, led by Jane Walker.

“Our findings suggest that, despite their rapid deterioration, successful clinical trials can be done in patients with poor prognosis cancers and comorbid major depression, by adapting both trial design and treatment delivery”, the team notes.

Gary Rodin, from University Health Network in Toronto, Ontario, Canada, praises the SMaRT Oncology trials in an accompanying editorial, citing the improvements in depression as a “testament” to the “nature of the treatment framework in which they took place”.

Nevertheless, he notes that it is impossible to “disentangle” the findings to determine the “most active ingredients” among the various collaborative interventions provided.

“Phased research is needed to establish the effect of specific components, and further studies are indicated to ascertain the benefit of minimal interventions or those tailored to address problems related to the cancer type or to the stage of disease”, he therefore concludes.


Walker J, Holm Hansen C, Martin P, et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psych 2014; Early online publication 28 August. doi:10.1016/S2215-0366(14)70313-X

Sharpe M, Walker J, Holm Hansen C, et al. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet 2014; Early online publication 28 August. doi:10.1016/S0140-6736(14)61231-9

Walker J, Holm Hansen C, Martin P, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMarT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. Lancet Oncol 2014; Early online publication 28 August. doi:10.1016/S1470-2045(14)70343-2

Rodin G. Effective treatment for depression in patients with cancer. Lancet 2014; Early online publication 28 August. doi:10.1016/S0140-6736(14)61342-8

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