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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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Maddie Kennedy October 23, 2014

Having read the above , I am relieved to know that it is acceptable to feel depressed, having not admitted this to myself . Family and friends were saying I was not right. Living with Cancer hanging over one is that surprising. The above information has helped me, along with helping myself ..by renewing my activities swimming and looking after grandchildren.

Aine McCarthy October 16, 2014

Dear Derek,

We’re sorry to hear about your diagnosis. You can give our Cancer Information nurses a ring on freephone 0808 800 4040 (9am-5pm, Monday to Friday) or send them an email through this form. We also have some links on our website about coping emotionally that you may find helpful.

Best Wishes,

Áine, Cancer Research UK

derek October 15, 2014

hi my name is derek i have had kidney cancer in 2010. bladder and prostate in 2011. have not been able to work since. i am 62. since i have a stoma. and a hernia. waiting to find out if i can have an operation. with no help from the government. it does make me depressed.

Aine McCarthy October 6, 2014

Dear All,

Thank you for all your comments.

John, we’re very sorry to hear about your wife and wish her, you and your family all the best. If you or a member of your family would like more information please give our Cancer Information nurses a ring on freephone 0808 800 4040 (9am-5pm, Monday to Friday) or send them an email through this form. We also have some information and practical advice about coping emotionally on our website.

Best wishes,

Áine, Cancer Research UK

Ray Sigsworth October 3, 2014

This sounds a marvelous development. i was fortune to be able to carry out a small piece of research involving using reflexology with clients suffering from depression who attended a group in Huddersfield.None were suffering from cancer but the results were generally very positive. The study was then published on the Federation of holistic Therepies website.The treatment was found to be very relaxing and gave them support in difficult times.I am sure that the therapy would also help cancer patients suffering from depression.

Davina Kennedy October 3, 2014

This sound good to me. I have cried, been angry, felt hopeless not all at once I find myself giving my nearest and dearest the Highs and concealing the lows. I am fortunate to have support from my Doctor/s, my oncology team and my Oncology Doctor.

Iva McCartney October 3, 2014

There seems to be even less awareness of the fact that depression and anxiety are actually one of the symptoms of cancer, even before diagnosis. In my personal experience, as well as that of several friends and relatives (some with terminal cancers, others with curable ones), depression, anxiety and personality changes were all present well before anyone was aware of what was going on.
I could have gone to my GP and said “I’ve been feeling down for months and that’s just not typical for me” and the most I would have got would have been anti-depressants. I realise it’s hard to pinpoint cancer without any other obvious symptoms, but it would be good if people are made aware that any persistent unexplained changes in mood should be investigated, rather than being put down to age, over-work or PMT.

Jackie Smith October 3, 2014

I am thrilled that this issue is being treated with more importance. My previously happy 20 year marriage ended due to my husband having depression and changing into a completely different person over the four year period post diagnosis, even though his outlook was said to be very good. Physically he is well, but mentally he is still in a very dark place some 7 years after the initial diagnosis.

Barbara-Ann Hogarth October 3, 2014

Good story , I have had a stroke and cancer twice in the last three year it came back in my liver but I try to live and enjoy life as much as possible it would be so easy to go down the road of staying in but with a young daughter and my husband they are my driving force, a horrible illness my heart goes out to everyone from family and friends, take care everyone x x x

John Davies October 3, 2014

My wife has cancer and has been depressed since she was diagnosed with oesophageal cancer in June 2013, it has very difficult time as a family trying cope with this problem. We have
tried to convince my wife and mother to live a normal life and enjoy the limited future.this l think we have only had very small success, cancer has spread to her stomach and pelvis
and her life with us is disappearing very quickly. My personal thoughts are we have let
my wife down and feel something could have been done to improve this situation

Jo October 2, 2014

This is brilliant it’s been 3 years for me post breast cancer diagnosis at 37 I’ve been so busy looking after the kids I haven’t sorted my head out and this is definitely what I need to do booked to the see the hospital counsellor as I’ve left it far too long.

Kerry-Anne Fowler October 2, 2014

I really struggled with my existing depression after I’d finished all my treatments for breast cancer (chemotherapy, radiotherapy & herceptin). Post treatment depression shouldn’t be ignored. I dealt with it myself by upping the dose of my existing medication but I couldn’t understand why I should feel worse after I’d seemingly come through the other side

Susie October 1, 2014

I was diagnosed with HER2 +ve Stage 3 breast cancer in 2009 and despite problems with chemotherapy – multiple pulmonary emboli, for example – manged to get through the treatment and subsequent radiotherapy taking little time off work. It was only when my husband was diagnosed with pelvic cancer this time last year, that I started to fall apart. He had 5 lots of surgery and is waiting to find out if he is now “clear”. In August 2014, I was almost unable to function due to anxiety and depression. Anti-depressants and a week’s holiday have helped enormously. My message is that you might pack away the cancer diagnosis, but at some point, it will probably need to be addressed, very empathetically by your medical team, or whomsoever has the skill to support those with cancer.

Good luck to all of you in the same boat.

Aine McCarthy October 1, 2014

Hi Ronny,
Thanks for your comment. We’re really pleased that you found the post interesting and inspiring.
All the best,
Áine, Cancer Research UK

Ronny Allan September 30, 2014

sorry cut and past error – see here http://wp.me/p4AplF-vv

Ronny Allan September 30, 2014

good blog. I just referenced this in my own personal blog here https://ronnyallan.wordpress.com/wp-admin/post.php?post=1953&action=edit wondered if you could pass this on to Aine to say thanks for helping with my inspiration and learning?

Kat Arney September 27, 2014

Dear Mary,
We’re sorry to hear about your diagnosis and wish you the very best for your travels. Please give our Cancer Information nurses a ring on freephone 0808 800 4040 (9am-5pm, Monday to Friday) or send them an email through this form: https://www.cancerresearchuk.org/about-cancer/utilities/contact-us/send-a-question/?secure=true. There are also useful links on our website about coping emotionally, as well as practical advice: http://www.cancerresearchuk.org/about-cancer/coping-with-cancer/coping-emotionally/
Best wishes,
Kat

Mary Fox September 27, 2014

Great article, depression is a large part in survival. I have rectal cancer and was given 6 months. I am leaving for Kenya on 6 October. Is there any literature I could find before leaving? Would be very grateful