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. 2011;6(11):e27181.
doi: 10.1371/journal.pone.0027181. Epub 2011 Nov 14.

Depression screening and patient outcomes in cancer: a systematic review

Anna Meijer  1 , Michelle Roseman, Katherine Milette, James C Coyne, Michael E Stefanek, Roy C Ziegelstein, Erin Arthurs, Allison Leavens, Steven C Palmer, Donna E Stewart, Peter de Jonge, Brett D Thombs
Affiliations

Depression screening and patient outcomes in cancer: a systematic review

Anna Meijer et al. PLoS One. 2011.

Abstract

Background: Several practice guidelines recommend screening for depression in cancer care, but no systematic reviews have examined whether there is evidence that depression screening benefits cancer patients. The objective was to evaluate the potential benefits of depression screening in cancer patients by assessing the (1) accuracy of depression screening tools; (2) effectiveness of depression treatment; and (3) effect of depression screening, either alone or in the context of comprehensive depression care, on depression outcomes.

Methods: Data sources were CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO and SCOPUS databases through January 24, 2011; manual journal searches; reference lists; citation tracking; trial registry reviews. Articles on cancer patients were included if they (1) compared a depression screening instrument to a valid criterion for major depressive disorder (MDD); (2) compared depression treatment with placebo or usual care in a randomized controlled trial (RCT); (3) assessed the effect of screening on depression outcomes in a RCT.

Results: There were 19 studies of screening accuracy, 1 MDD treatment RCT, but no RCTs that investigated effects of screening on depression outcomes. Screening accuracy studies generally had small sample sizes (median = 17 depression cases) and used exploratory methods to set sample-specific cutoff scores that varied substantially across studies. A nurse-delivered intervention for MDD reduced depressive symptoms moderately (effect size = 0.37).

Conclusions: The one treatment study reviewed reported modest improvement in depressive symptoms, but no evidence was found on whether or not depression screening in cancer patients, either alone or in the context of optimal depression care, improves depression outcomes compared to usual care. Depression screening in cancer should be evaluated in a RCT in which all patients identified as depressed, either through screening or via physician recognition and referral in a control group, have access to comprehensive depression care.

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Conflict of interest statement

Competing Interests: The authors have read the journal‘s policy and have the following conflicts: one co-author, Dr. Stewart, is a consultant for the Depression Global Advisory Board for Eli Lilly, and the Cymbalta Pregnancy Registry, and was a consultant for the Depression Advisory Board for Wyeth until 2009. All other authors have declared that no competing interests exist. This does not alter the authors‘ adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. USPSTF Framework for Evaluating Screening Programs.
Figure 2
Figure 2. PRISMA Flow Diagram of Study Selection Process for Key Question #1.
Figure 3
Figure 3. PRISMA Flow Diagram of Study Selection Process for Key Question #2.
Figure 4
Figure 4. PRISMA Flow Diagram of Study Selection Process for Key Question #3.
See this image and copyright information in PMC

References

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    1. National Comprehensive Cancer Network. Distress Management. 2008. NCCN clinical practice guidelines in oncology. http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf.
    1. Institute of Medicine. Cancer care for the whole patient: meeting psychosocial health needs. Washington, DC: National Academy Press; 2007. 430
    1. Ng CG, Boks MP, Zainal NZ, De Wit NJ. The prevalence and pharmacotherapy of depression in cancer patients. J Affect Disord. 2011;131:1–7. - PubMed

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