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An article published in The Lancet finds that
cancer patients who received a care package called "Depression Care for
People with Cancer" (DCPC) had lower levels of depression than those
who received the usual care (antidepressants and mental health services
recommended by the cancer team). Professor Michael Sharpe (University
of Edinburgh, UK) and other colleagues who study psychological medicine
also found that as a way of improving the quality of life of cancer
patients, DCPC is more cost-effective than the current cancer
treatments.
It is not uncommon for patients suffering from disorders such as cancer
to experience major depression - a condition that sharply reduces
quality of life. The medical community, however, lacks substantial
research that can assist physicians in helping patients manage
depression. In order to add to this scarce body of evidence, Sharpe and
colleagues conducted the SMaRT (Symptoms Management Research Trials)
oncology 1 trial to study this new complex care package (DCPC)
specially designed for cancer patients with depression and delivered by
nurses.
Funded by Cancer Research UK, the trial consisted of 200 patients - all
with a cancer prognosis of more than six months and major depression -
selected from a regional cancer center in Scotland. The patients were
about 56.6 years, on average, and 71% were women (141 of 200). In the
randomization process, 99 patients were placed in a group that received
the usual care of antidepressants and mental health referrals that
depressed cancer patients receive from their general practitioner and
cancer team. The other 101 patients were placed in a group that
received the usual care in addition to Buy generic viagra DCPC.
The DPCP consisted of about seven one-on-one counseling sessions (over
three months) with a trained cancer nurse. In these sessions, the
nurses provided information about depression and ways to treat it (such
as information on the various antidepressant medications). As a method
of preventing feelings of helplessness among cancer patients, the
nurses also offered problem-solving treatment. Not only did the nurses
remain in contact with each patient’s oncologist and primary-care
doctor to discuss depression management, but they also monitored
progress via telephone after the sessions were completed. If necessary,
nurses would meet with patients for optional additional sessions. The
researchers used two methods to measure depression in both groups: 1)
the self-reported Symptom Checklist-20 depression scale, range 0 to 4,
and 2) interviews after three, six, and 12 months.
Sharpe and colleagues found that patients who received DCPC had a lower
depression level - by 0.34 on the scale - than those who did not
receive DCPC. The treatment group also had a major depression rate that
was 23% lower than in the usual care group. After 12 months, the
benefits from the DCPC intervention were still evident. Although the
DCPC did not reduce pain or improve physical functioning, it did help
patients who were suffering from anxiety and fatigue.
The researchers claim that DCPC is potentially cost-effective. Studying
the numbers, the researchers report that the per patient cost
of DCPC over six months is ??336 (US$668), which can be expanded to
??5278 per quality-adjusted life-year gained. This figure can be
compared to the median level of cost per quality-adjusted life-year
gained of about ??10,000 (US$20,000) for anti-cancer treatments in
general.
"The intervention - Depression Care for People with Cancer - offers a
model for the management of major depressive disorder in patients with
cancer and other medical disorders who are attending special medical
services that is feasible, acceptable, and potentially cost effective,"
conclude the authors.
An accompanying Comment, written by Professor Gary Rodin (Princess
Margaret Hospital, University Health Network, Toronto, ON, Canada),
notes that, "In a well-designed study, Sharpe and colleagues 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. Such multicomponent
interventions are potentially feasible in cancer treatment centres and
can be perceived by patients as less stigmatising than referral to a
mental health specialist."
Management of depression for people with cancer (SMaRT
oncology 1): a randomised trial
Vanessa Strong, Rachel Waters, Carina Hibberd, Gordon Murray, Lucy
Wall, Jane Walker, Gillian McHugh, Andrew Walker, Michael Sharpe
The Lancet (2008). 372(9632): pp. 40-48.
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Here to View Journal Website
Written by: Peter M Crosta
Copyright: Medical News Today
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Tags: antidepressant, antidepressants, anxiety, depression

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