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Cancer therapy

A SMaRT-approach to depression might improve cancer survival

Nature Reviews Clinical Oncology volume 11, page 561 (2014)Cite this article

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Depression is said to be the least noticed symptom in people with cancer and yet it represents a major problem, affecting patients quality of life (QoL) and survival. The psychological medicine research groups of the Universities of Oxford and Edinburgh published three linked papers on major depression and cancer. Importantly, the two groups led by Jane Walker and Michael Sharpe, reported that recognizing and treating depression in patients with cancer improves pain, fatigue, QoL and might also improve survival.

In the second study, the two groups addressed the problem of inadequate treatment. “We developed a new treatment programme called 'Depression Care for People with Cancer' (DCPC),” explains Sharpe. The DCPC programme, including both antidepressants and psychological therapy, is delivered, as part of cancer care, by a team of specially trained nurses and psychiatrists working in collaboration with the patient's doctors. The investigators started the SMaRT Oncology-2 trial, a large randomized trial evaluating 500 adults with major depression and a cancer with a good prognosis (predicted survival ≥12 months), to compare the effectiveness of DCPC versus usual care. The DCPC programme was strikingly more effective at reducing depression than usual care. As Sharpe and Walker highlight, “at 6 months, 62% of the patients who received DCPC responded to treatment (at least a 50% reduction in the severity of depression) compared with only 17% of those who received usual care. This benefit was sustained at 12 months.” Of note, DCPC also improved anxiety, pain, fatigue, functioning, and was a cost-effective means to improve overall QoL.

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References

  1. Walker, J. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry 10.1016/S2215-0366(14)70313-X

  2. Sharpe, M. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. Lancet 10.1016/S0140-6736(14)61231-9

  3. Walker, J. 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. Lancet Oncol. 10.1016/S1470-2045(14)70343-2

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Authors
  1. Alessia Errico
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Errico, A. A SMaRT-approach to depression might improve cancer survival. Nat Rev Clin Oncol 11, 561 (2014). https://doi.org/10.1038/nrclinonc.2014.154

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  • DOI: https://doi.org/10.1038/nrclinonc.2014.154

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