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. 2020 Jul;25(7):e1098-e1108.
doi: 10.1634/theoncologist.2019-0709. Epub 2020 Feb 26.

Gaps in the Management of Depression Symptoms Following Cancer Diagnosis: A Population-Based Analysis of Prospective Patient-Reported Outcomes

Julie Hallet  1   2   3   4 , Laura E Davis  3 , Elie Isenberg-Grzeda  5 , Alyson L Mahar  6 , Haoyu Zhao  4 , Victoria Zuk  3 , Lesley Moody  7 , Natalie G Coburn  1   2   3   4   7
Affiliations

Gaps in the Management of Depression Symptoms Following Cancer Diagnosis: A Population-Based Analysis of Prospective Patient-Reported Outcomes

Julie Hallet et al. Oncologist. 2020 Jul.

Abstract

Background: One of the most common psychological morbidities of cancer is depression. Routine depression symptoms screening (DSS) is recommended, but its ability to lead to psychosocial interventions in clinical practice is limited. We examined the use of and factors associated with psychosocial interventions for positive DSS following cancer diagnosis.

Materials and methods: We conducted a population-based cohort study of patients with diagnoses from 2010 to 2017 who reported ≥1 patient-reported Edmonton Symptom Assessment System (ESAS) score. Positive DSS was defined as ESAS ≥2 out of 10 for the depression item within 6 months of diagnosis. Outcomes were psychosocial interventions around the time of positive DSS: palliative care assessment, psychiatry/psychology assessment, social work referral, and antidepressant therapy (in patients ≥65 years of age with universal drug coverage). We examined reduction in depression symptom score (≥1 point) following intervention. Modified Poisson regression examined factors associated with interventions.

Results: Of 142,270 patients, 65,424 (46.0%) reported positive DSS at a median of 66 days (interquartile range: 34-105) after diagnosis. Of those with depression symptoms, 17.1% received palliative assessment, 1.7% psychiatry/psychology assessment, 8.4% social work referral, and 4.3% antidepressant therapy. Depression symptom score decreased in 67.2% who received palliative assessment, 63.7% with psychiatry/psychology assessment, 67.3% with social work referral, and 71.4% with antidepressant therapy. On multivariable analysis, patients with older age, rural residence, lowest income quintile, and genitourinary or oropharyngeal cancer were more likely to not receive intervention other than palliative care.

Conclusion: The proportion of patients reporting positive DSS after cancer diagnosis receiving psychosocial intervention is low. We identified patients vulnerable to not receiving interventions, who may benefit from additional support. These data represent a call to action to modify practice and optimize the usefulness of systematic symptom screening.

Implications for practice: Patient-reported depression symptoms screening should be followed by targeted interventions to improve symptoms and patient-centered management.

Keywords: Depression; Distress; Patient-reported outcomes; Supportive care.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1
Figure 1
Flow diagram of cohort creation. Abbreviation: ESAS, Edmonton Symptom Assessment System.
Figure 2
Figure 2
Receipt of psychosocial intervention stratified by patient‐reported depression.
Figure 3
Figure 3
Receipt of psychosocial intervention with patient‐reported depression. Proportions represent the proportion of patients receiving the intervention within each cancer type (row percentages).
Figure 4
Figure 4
Change in ESAS depression score following psychosocial intervention with patient‐reported depression. Abbreviation: ESAS, Edmonton Symptom Assessment System.
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