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New approaches are needed for tackling depression in cancer patients.

Depression is an important but largely under-recognised problem for people with cancer. It’s often forgotten that this complex disease can not only affect the physical, but also the mental health and general wellbeing of people living with cancer.

New studies published in The Lancet Psychiatry, The Lancet and The Lancet Oncology show that three-quarters of depressed cancer patients do not receive effective treatment for their depression.  But the good news is that a new treatment programme could reduce their depression and greatly improve their quality of life.

With mental health in the headlines lately, these findings are as timely as they are important – they highlight that when someone is diagnosed, it’s vital the whole person is treated and not just the cancer.

Researchers at the University of Edinburgh and University of Oxford, led by Professor Michael Sharpe and Dr Jane Walker, carried out the research to identify how common depression is among people with cancer and to find out if current therapies could be improved. What they found is impressive.

Depression and cancer – what’s the story?

It might sound obvious to say that many people living with cancer have feelings of depression or anxiety – but it is important to make the distinction between natural feelings of worry and sadness that many people would feel at such a difficult time, and more severe conditions. In this trilogy of studies, the researchers focused on clinical depression – a low which lasts a long time and interferes with a person’s ability to function or take an interest in day-to-day life.

While people often feel depressed when they are diagnosed with cancer, clinical depression in cancer patients can, and often does, go unnoticed and untreated. This may be because people expect to feel down – quite understandably. But it may also be because doctors are most concerned about treating the physical disease, rather than addressing mental health concerns.

While it is of course natural to be upset when diagnosed with cancer, and it is extremely important to tackle the cancer first and foremost, it is also important that doctors look after the mental health of people living with cancer and that patients talk to their doctors about how they are feeling mentally as well as physically.

By taking a broader approach to the general health of cancer patients, doctors can not only treat their disease but also improve their overall quality of life.

Measuring the problem – and trying to solve it

The first part of this trilogy, published in The Lancet Psychiatry, tells how doctors and scientists studied more than 21,000 patients who visited cancer clinics in Scotland and looked at how many had major depression. In the study, the largest ever of its kind, researchers found that depression is up to six times more common in people with cancer compared to the general population, where the rate is generally around two per cent.

In particular, patients who had a poor outlook – meaning they were expected to survive less than one year – were more likely to be affected. For example, 13 in every 100 lung cancer patients included in this study were diagnosed with depression, compared to six in every 100 patients with genitourinary cancer.

This study also shows that treatment of cancer patients with depression is currently not very good. Although treatments such as antidepressants may be offered, up to three in four patients do not receive any treatment for their depression at all.

The second installment of this trio of studies, published in the Lancet looks at Symptom Management Research Trial in Oncology (or SMaRT Oncology-2 for short) – a clinical trial which aimed to improve treatment of depression in people with cancer. The researchers developed a new treatment programme called ‘Depression Care for People with Cancer’ (DCPC), and compared it to the current treatment for depressed cancer patients.

While cancer patients with depression are typically treated through their GP, DCPC involves a team of specially trained nurses and psychiatrists working alongside GPs and specialist cancer doctors.  As well as offering antidepressants, DCPC involves encouraging patients to increase their activity and continue doing things they love, such as playing golf or taking their grandchildren to the beach.

Nurses also help patients with problem solving, where people identify and talk through issues they are having, big or small. The main aim of the therapy is to help patients regain control of their lives. DCPC treatment is intensive, organised and built-in to patients’ cancer treatment. Another big advantage is that it is very cost-effective – at £613 per patient, a course of DCPC is a fraction of the price of expensive cancer drugs or other treatments.

In their study, the researchers treated 500 people whose cancers had a better outlook – where survival was expected to be at least one year – with either DCPC or the current standard treatment.  They found that after six months, nearly 62 per cent of patients who received DCPC had a 50 per cent improvement in the level of their depression – compared to just 17 per cent of patients who had standard treatment.

Patients who had had DCPC also reported better overall health, feeling less anxious and a generally improved quality of life. According to one patient who took part in the trial, “The cancer team gave me a new life; the DCPC team have given me back my spirit and personality”.

The final part in this blockbusting trilogy, in The Lancet Oncology, looked at how effective DCPC was at treating patients with a poorer outlook. In this case the researchers focused on lung cancer, which is often diagnosed at a late stage, making it difficult to treat.

142 people with lung cancer were treated using current treatment options or a modified DCPC programme which was more suitable for people with advanced cancer – for example, allowing patients to speak with nurses in their own homes. Yet again, DCPC was shown to be better at treating depression compared with current treatments. After eight months, DCPC treated patients were less depressed, less anxious and reported a better overall quality of life.

A brighter future

Living with cancer or depression can be hard – battling both together is even more difficult. This trilogy of exciting new studies, partly funded by Cancer Research UK, provides valuable insight into knowing who is more likely to suffer from depression after a cancer diagnosis. And they tell us how treating the condition can improve wellbeing and reduce treatment side effects for patients.

This research also shows that diagnosing depression in cancer patients is not enough – better treatment is urgently needed. The researchers found that people with cancer often accept their feelings of depression and didn’t recognise them as symptoms that could be treated. Through a hands-on, tailored approach, the DCPC treatment programme can solve this problem by helping cancer patients understand these feelings and realise they can be improved – and does so in a cost-effective way.

These new findings won’t immediately change how doctors treat depression in people with cancer, but they do offer a fresh alternative to current approaches.

 Aine

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