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University of Edinburgh researchers have developed a new approach for treating depression in cancer patients, and results from the program's first trial were very encouraging. The program, which is given by specially-trained cancer nurses, is designed to work alongside a patient's usual cancer care. It emphasizes screening for depression, antidepressant medication, and teaching patients problem-solving skills.

"The business of medicine isn't just about making people live longer, it's about making them feel better," said lead researcher Michael Sharpe MD, Professor of Psychological Medicine. "This approach is about improving quality-of-life for cancer patients, and doing it in a realistic way that's integrated with their cancer care."

An Integrated Approach

The researchers screened patients for symptoms of depression who were being treated for breast, colorectal, gynecological, blood, lung, and other cancers at southeast Scotland-based clinics. Patients first completed a questionnaire, and those with high depression and anxiety scores were then interviewed by telephone.

Two hundred cancer patients participated in the trial. All of the patients were expected to live at least 6 months. The mean age was 56.6, and 141 (71%) were women. Eighty seven of the patients had breast cancer, 31 had gynecological cancer, and 13 had colorectal cancer. Sixty-nine of the participants had other cancer types, including prostate, blood, testicular, urinary tract, lung, skin cancer, and sarcoma.

Sharpe and his colleagues randomly assigned 99 of the participants to receive usual care and 101 to receive usual care and the depression program. Over a 3-month period, the latter participants had up to 10 45-minute sessions with the nurses.

The nurses were specifically trained in depression management and supervised by psychiatrists, but were not required to have formal academic training in psychiatric nursing. The heart of the program was a 76-page manual called Depression Care of People with Cancer authored by Sharpe and his colleagues. It covered topics like taking antidepressants appropriately, being active, and learning to cope with problems better.

At 3 months, scores for depression fell in both groups, though by a significantly greater amount in the group working with the nurses. The numbers held at 6- and 12-months. In both groups, there was a significant increase in antidepressant use. Patients in the intervention group reported less anxiety and fatigue at both 3 and 6 months compared to those receiving usual care only.

"Our results were encouraging, surprisingly long-lasting, and the costs were relatively modest," says lead researcher Sharpe. "This shows that treating depression can work well when it's part and parcel of a patient's cancer care. However, there's more work that needs to be done to show that this approach can work in practice before we can recommend implementation of this model on a large scale; we are doing that work now.”

Costs of Care

Treating depression this way does come with a price tag, however. It requires additional nursing positions and hiring nurses with advanced education. It also means higher costs for patients who may need to pay for prescription drugs.

The average cost of the intervention including nurse time and psychiatrist supervision, as well as higher costs for health care and antidepressant drug usage, was $670 per patient. Sharpe and colleagues did not include the cost of nurse training or the cost of screening the patients in this number. They're working on a detailed cost-analysis in a second trial.

"This is a good use of oncology nurses' qualifications," said Marcia Grant, RN, DNSc, FAAN, Professor and Director of the Department of Nursing Research and Education, Co-Director of the Program for Cancer Control and Population Science of the Cancer Center at the City of Hope Comprehensive Cancer Center. Grant, who was not involved in the research, felt that similar programs could be implemented in the United States -- "It's really what's needed for advancing the psychological well-being of cancer patients."

Additional research currently underway will also try this approach in patients with other cancer types. Sharpe is also planning a series of clinical trials that use a similar approach to simultaneously address pain and other symptoms.