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Undiagnosed depression common among patients with cancer
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Forty percent of adults at an urban cancer center received a diagnosis of depression, according to a study presented at the American Society for Radiation Oncology Annual Meeting.
Of those patients, 75% had previously been undiagnosed.
“Historically, depression has been underrecognized and undertreated in the oncology population, leading to decreased quality of life and potentially poorer outcomes in these patients,” Jason Domogauer, PhD, MD/PhD candidate at Rutgers University Medical School, told HemOnc Today. “Further, oncology patients from urban centers — especially those of low socio-economic backgrounds — have not been adequately studied.”
The combination of physiological, psychological and socioeconomic factors associated with cancer — including severe physical pain, side effects of medication, financial concerns, anxieties about mortality, and changes in lifestyle and life plans — increase the risk for depression among patients with cancer. The NCI estimates that 15% to 25% of the cancer population experiences depression, a rate two to three times that of the general population.
Researchers analyzed data from 400 adults with cancer (median age, 55 years; range, 20-86 years; 53% women; 48% black or African-American; 29% white; 16% Hispanic or Latino) who received treatment at the University Hospital Cancer Center in Newark, New Jersey, between 2013 and 2016.
Researchers assessed depression using a minimum score of 16 on the Center for Epidemiologic Studies — Depression scale.
Roughly half of patients (49%) reported being able to work whereas 51% could not due to disability.
Most patients (85%) received radiation therapy as part of their treatment.
Clinicians diagnosed depression in 40% of patients. Three out of four of those patients were diagnosed with depression for the first time, meaning about 30% of patients suffered from undiagnosed and untreated depression, according to the researchers.
Depression appeared more common among women than men (47% vs. 32%; OR = 1.9; P = .007) and among individuals unable to work due to disability than those who could work (48% vs. 33%; OR = 1.9; P = .005). Depression prevalence did not differ significantly among racial and ethnic groups.
Among those who had not been previously diagnosed, depression again appeared more common among women (43% vs. 29%; OR = 1; P = .02) and patients disabled by their disease (43% vs. 31%; OR = 1.9; P = .03).
“Our findings point to a clear need for action, including depression screening during initial and continuing patient visits, initiation of mental health treatments for identified patients and increased collaboration with mental health providers in cancer treatment centers,” Domogauer said. “These efforts are particularly important for patients in urban centers, those who are female and those unable to work because of their disease. We believe it is important for oncology providers to actively engage patients in conversations concern mental health, including depressive symptoms.”
Future studies exploring the underlying factors contributing to these observed differences in patients with cancer are needed, Domogauer said.
“Further investigation into the long-terms effects of untreated depression in these patients is essential,” he said. “Also, the benefits of improved integration of mental health treatment on patient quality of life and outcomes need to be evaluated.” – by Chuck Gormley
Reference:
Domogauer JD, et al. Abstract LBA-21. Presented at: American Society for Radiation Oncology Annual Meeting; Sept. 24-26, 2017; San Diego.
Disclosures: Researchers report no relevant financial disclosures.
Perspective
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Brian Kavanagh, MD, MPH, FASTRO
We are trying to raise awareness of the many facets and challenges that our patients experience. We need to be comprehensive in that regard if we are trying to optimize the quality of care for our patients. We must be very sensitive to the struggles they are facing with mood problems, the financial struggles and their fears about cancer treatment, and we need to know the lasting impact of all of these factors put together.
The diagnosis of cancer is a frightening prospect for every patient under any circumstance. It’s possible that the timing of radiation therapy along the course of a patient’s illness may have some impact upon that. A deluge of information comes at a patient from the moment of a biopsy suggesting cancer, to possibly a surgery that removes the bulk of the cancer, and then the patient is catching his or her breath when it might be recommended they have additional [radiation] therapy. Sometimes it’s that pause between that gives some patients an opportunity to feel some of the stress. Independent of that, a patient would be expected to have anxiety about potential side effects and fear about how they will do.
A conversation with the patient is something that, by itself, can calm a lot of fears. Seeing other patients come and go from the clinic without much difficulty is a soothing relief for patients while they are undergoing treatment. It is important for patients to know the typical side effects of radiation, that they are generally mild, and that there are many ways to mitigate and manage them. But, patients with cancer will be understandably anxious and may be more heavily affected in their moods, with depression as a consideration. That may be a further extension of anxiety and fears around treatment, and the seriousness of the diagnosis underlying the reason for getting treatment.
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