There is a high prevalence of untreated depression in patients with cancer and an integrated treatment programme is more effective than standard care in alleviating symptoms and improving quality of life, according to three papers published in The Lancet.
The new treatment programme, known as depression care for people with cancer (DCPC), is delivered by a team of cancer nurses and psychiatrists working with the patient’s GP. It includes both antidepressant and psychological therapy and is given as part of cancer care.
DCPC was evaluated in 500 patients with good-prognosis cancer in the SMaRT Oncology-2 trial, published in The Lancet
, and in 142 patients with lung cancer — which has a typically poor prognosis — in the SMaRT Oncology-3 trial, published in The Lancet Oncology
. In both trials, DCPC was more effective than standard care for treating major depression and also led to improvements in anxiety, functioning and quality of life. In SMaRT Oncology-2, 62% of the patients who received DCPC responded to treatment (at least a 50% reduction in the severity of their depression) at six months, compared with only 17% of those who received standard care.
Steve Williamson, consultant cancer pharmacist at Northumbria & North Cumbria NHS Trusts, called for similar programmes to be adopted in UK chemotherapy units.
Lancet papers should prompt a review of trusts’ current arrangements to recognise and support cancer patients with depression,” says Williamson. “The key message for pharmacists coming into contact with cancer patients is to be aware of the local referral mechanisms and not be afraid to raise concerns and help patients get the support they need.”
Much-needed data on the prevalence of co-morbid depression and cancer are provided in a third paper, published in The Lancet Psychiatry
. Jane Walker, from the University of Oxford, and colleagues analysed data from 21,151 patients who underwent routine screening for depression at cancer clinics in Scotland.
The prevalence of major depression varied by cancer site, at 13.1% in those with lung cancer, 10.9% in gynaecological cancer, 9.3% in breast cancer, 7.0% in colorectal cancer and 5.6% in genitourinary cancer. Worryingly, three quarters of patients with major depression were not receiving effective treatment.
“A pressing need exists to improve the management of major depression for patients attending specialist cancer services,” Walker and colleagues write in the paper.
Walker was lead author of SMaRT Oncology-3, believed to be the first randomised controlled trial to assess a treatment for patients with major depression and lung cancer. She says that although DCPC was clearly more effective than standard care in treating depression, its cost-effectiveness is still to be determined.
“Further adaptation of the treatment will be necessary to address the unmet needs of patients with major depression and even shorter life expectancy,” she adds.
 Sharpe M et al. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. The Lancet. Available from: (published 28 August 2014).
 Walker J 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. The Lancet Oncology (published 28 August 2014).
 Walker J et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. The Lancet Psychiatry (published 28 August 2014).