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Grassi L, Caruso R, Riba MB, Lloyd-Williams M, Kissane D, Rodin G, McFarland D, Campos-Ródenas R, Zachariae R, Santini D, Ripamonti CI. Anxiety and depression in adult cancer patients: ESMO Clinical Practice Guideline. ESMO Open 2023; 8:101155. [PMID: 37087199 PMCID: PMC10163167 DOI: 10.1016/j.esmoop.2023.101155] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/27/2023] [Accepted: 01/29/2023] [Indexed: 03/15/2023] Open
Abstract
•Anxiety and depressive disorders are common in patients with cancer. •A higher prevalence seen in patients with cancer than the general population is often underrecognised. •Psychotherapy, cognitive behavioural therapy and mindfulness-based therapies are effective treatments. •Psychopharmacological treatments have been shown to be effective treatments of anxiety and depressive disorders.
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Affiliation(s)
- L Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - R Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - M B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor; University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, USA
| | - M Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool; Department of Supportive and Palliative Care, Liverpool John Moores University, Liverpool, UK
| | - D Kissane
- Department of Psychiatry, Monash University and Monash Medical Centre, Monash Health, Clayton, Australia
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - D McFarland
- Department of Psychiatry, University of Rochester, Rochester; Wilmont Cancer Institute, University of Rochester Medical Center, Rochester, USA
| | - R Campos-Ródenas
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - R Zachariae
- Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus; Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - D Santini
- UOC Medical Oncology, AUSL Latina, Sapienza University of Rome, Aprilia
| | - C I Ripamonti
- Oncology-Supportive Care in Cancer, Department of Oncology & Haematology Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan, Italy
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2
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Schipper S, Nigam K, Piechotta V, Ljuslin M, Beaussant Y, Schwarzer G, Boehlke C. Psychedelic/entactogen‐assisted therapy for treatment of anxiety, depression and existential distress in adult palliative care. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022; 2022:CD015383. [PMCID: PMC9677948 DOI: 10.1002/14651858.cd015383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of psychedelic/entactogen‐assisted therapy compared to placebo or active comparators (e.g. antidepressants) for treatment of anxiety, depression, and existential distress in adult palliative care.
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Affiliation(s)
| | | | - Kabir Nigam
- Department of PsychiatryBrigham and Women’s HospitalBostonUSA
| | - Vanessa Piechotta
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cochrane HaematologyFaculty of Medicine and University Hospital Cologne, University of CologneCologneGermany
| | - Michael Ljuslin
- Palliative Medicine Division, Department of Rehabilitation and GeriatricsGeneva University HospitalsGenevaSwitzerland,Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA,Harvard Medical SchoolBostonUSA
| | - Yvan Beaussant
- Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA
| | - Guido Schwarzer
- Institute of Medical Biometry and StatisticsFaculty of Medicine and Medical Center, University of FreiburgFreiburgGermany
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3
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Haas O, Lopera Gonzalez LI, Hofmann S, Ostgathe C, Maier A, Rothgang E, Amft O, Steigleder T. Predicting Anxiety in Routine Palliative Care Using Bayesian-Inspired Association Rule Mining. Front Digit Health 2021; 3:724049. [PMID: 34713190 PMCID: PMC8521932 DOI: 10.3389/fdgth.2021.724049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
We propose a novel knowledge extraction method based on Bayesian-inspired association rule mining to classify anxiety in heterogeneous, routinely collected data from 9,924 palliative patients. The method extracts association rules mined using lift and local support as selection criteria. The extracted rules are used to assess the maximum evidence supporting and rejecting anxiety for each patient in the test set. We evaluated the predictive accuracy by calculating the area under the receiver operating characteristic curve (AUC). The evaluation produced an AUC of 0.89 and a set of 55 atomic rules with one item in the premise and the conclusion, respectively. The selected rules include variables like pain, nausea, and various medications. Our method outperforms the previous state of the art (AUC = 0.72). We analyzed the relevance and novelty of the mined rules. Palliative experts were asked about the correlation between variables in the data set and anxiety. By comparing expert answers with the retrieved rules, we grouped rules into expected and unexpected ones and found several rules for which experts' opinions and the data-backed rules differ, most notably with the patients' sex. The proposed method offers a novel way to predict anxiety in palliative settings using routinely collected data with an explainable and effective model based on Bayesian-inspired association rule mining. The extracted rules give further insight into potential knowledge gaps in the palliative care field.
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Affiliation(s)
- Oliver Haas
- Department of Industrial Engineering and Health, Institute of Medical Engineering, Technical University Amberg-Weiden, Weiden, Germany.,Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | | | - Sonja Hofmann
- Department of Palliative Medicine, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Department of Computer Science, Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | - Eva Rothgang
- Department of Industrial Engineering and Health, Institute of Medical Engineering, Technical University Amberg-Weiden, Weiden, Germany
| | - Oliver Amft
- Chair of Digital Health, Friedrich-Alexander University, Erlangen-Nürnberg, Germany
| | - Tobias Steigleder
- Department of Palliative Medicine, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
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Hallet J, Davis LE, Isenberg-Grzeda E, Mahar AL, Zhao H, Zuk V, Moody L, Coburn NG. Gaps in the Management of Depression Symptoms Following Cancer Diagnosis: A Population-Based Analysis of Prospective Patient-Reported Outcomes. Oncologist 2020; 25:e1098-e1108. [PMID: 32100906 DOI: 10.1634/theoncologist.2019-0709] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
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.
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Affiliation(s)
- Julie Hallet
- Division of Surgical Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Laura E Davis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Elie Isenberg-Grzeda
- Division of Psycho-Social Services, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Natalie G Coburn
- Division of Surgical Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Cancer Care Ontario, Toronto, Ontario, Canada
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5
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Caruso R, Breitbart W. Mental health care in oncology. Contemporary perspective on the psychosocial burden of cancer and evidence-based interventions. Epidemiol Psychiatr Sci 2020; 29:e86. [PMID: 31915100 PMCID: PMC7214708 DOI: 10.1017/s2045796019000866] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/30/2019] [Indexed: 12/18/2022] Open
Abstract
With cancer incidence increasing over time worldwide, attention to the burden of psychiatric and psychosocial consequences of the disease is now mandatory for both cancer and mental health care professionals. Psychiatric disorders have been shown to affect at least 30-35% of cancer patients during all phases of the disease trajectory, and differ in nature according to stage and type of cancer. Other clinically relevant distressing psychosocial and existential conditions (e.g. demoralisation, health anxiety, loss of meaning and existential distress) not included as 'disorders' in the usual diagnostic and nosological systems (i.e. meta-diagnostic conditions) have also been shown to be present in another 15-20% of cancer patients. In this editorial, we will present a summary of the extensive literature regarding the epidemiology of the several psychosocial disorders affecting cancer patients as a cause of distress and burden to be taken into consideration and addressed in cancer care through evidence-based intervention.
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Affiliation(s)
- R. Caruso
- Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - W. Breitbart
- Department of Psychiatry & Behavioral Sciences, Jimmie C. Holland Chair in Psychiatric Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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McCabe MP, Goldhammer D, Mellor D, Hallford D, Davison T. Evaluation of A Training Program to Assist Care Staff to Better Recognize and Manage Depression among Palliative Care Patients and Their Families. J Palliat Care 2018. [DOI: 10.1177/082585971202800203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was designed to evaluate the effectiveness of a training program to improve the knowledge, attitudes, and self-efficacy of palliative care staff and thus enable them to better detect and manage depression among palliative care patients and their families. Participants were 90 professional carers who completed a four-session training program. Knowledge, attitudes, self-efficacy, and barriers to working with depressed patients were assessed pre-intervention, post-intervention, and at a three-month follow-up. The results demonstrated that compared to the control group, the intervention group had improved in all of these areas. Improvements were maintained at the three-month follow-up in all areas except attitudes. The results of this study indicate the importance of training in managing depression among palliative care staff. Booster sessions will likely be needed to ensure that training program gains are maintained.
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Affiliation(s)
- Marita P. McCabe
- MP McCabe (corresponding author): School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Denisa Goldhammer
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
| | - David Mellor
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
| | - David Hallford
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
| | - Tanya Davison
- D Goldhammer, D Mellor, D Hallford, T Davison: School of Psychology, Deakin University, Melbourne, Australia
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7
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Grassi L, Caruso R, Mitchell AJ, Sabato S, Nanni MG. Screening for emotional disorders in patients with cancer using the Brief Symptom Inventory (BSI) and the BSI-18 versus a standardized psychiatric interview (the World Health Organization Composite International Diagnostic Interview). Cancer 2018; 124:2415-2426. [PMID: 29660109 DOI: 10.1002/cncr.31340] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Given the adverse consequences of psychiatric and psychosocial morbidity on the quality of life for patients with cancer, prompt detection of psychological symptoms is mandatory. The authors examined the properties and accuracy of the Brief Symptom Inventory (the 53-item version [BSI] and the 18-item version [BSI-18]) for the detection of psychiatric morbidity compared with the World Health Organization Composite International Diagnostic Interview (CIDI) for International Classification of Diseases-10th Revision psychiatric diagnoses. METHODS A convenience sample of 498 patients with newly diagnosed cancer who were recruited in cancer outpatient services participated in the CIDI interview and in BSI and BSI-18 assessments. RESULTS The prevalence of psychiatric morbidity was 39.75%. When participants were classified as cases using the BSI standard case rule, agreement with the CIDI was potentially acceptable (sensitivity, 72.7%; specificity, 88.7%). In contrast, the accuracy of the BSI-18 in identifying cases was poor according to the standard case rule, with very low sensitivity (29.3%) (misclassification rate, 28.7%). By using a first alternative case-rule system (a BSI-18 global severity index [GSI] T-score ≥57), sensitivity marginally improved (45%), whereas a second alternative case-rule system (a GSI T-score ≥50) significantly increased sensitivity (77.3%). In receiver operating characteristic curve analysis, a further cutoff GSI T-score ≥48 exhibited good discrimination levels (sensitivity, 82.3%; specificity, 72.4%). There were some differences in GSI cutoff T-scores according to the International Classification of Diseases-10th Revision diagnosis and sex. CONCLUSIONS The BSI appeared to have acceptable diagnostic accuracy compared with a standardized psychiatric interview. For the BSI-18, it is mandatory to use alternative case-rule systems, to identify patients with psychiatric morbidity. Cancer 2018;124:2415-26. © 2018 American Cancer Society.
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Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Unit of Hospital Psychiatry, S. Anna Hospital and Health Authorities, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Unit of Hospital Psychiatry, S. Anna Hospital and Health Authorities, Ferrara, Italy
| | - Alex J Mitchell
- Department of Psycho-Oncology, Cancer, and Molecular Medicine, University of Leicester, Leicester, United Kingdom
| | - Silvana Sabato
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,University Unit of Hospital Psychiatry, S. Anna Hospital and Health Authorities, Ferrara, Italy
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8
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Caruso R, Nanni MG, Riba MB, Sabato S, Grassi L. The burden of psychosocial morbidity related to cancer: patient and family issues. Int Rev Psychiatry 2017; 29:389-402. [PMID: 28753076 DOI: 10.1080/09540261.2017.1288090] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With cancer incidence increasing over time, attention to the burden of related psychiatric and psychosocial consequences of the disease and treatment is a major topic for both cancer patients and their caregivers. Among cancer patients, psychiatric (e.g. adjustment, anxiety, depressive disorders) and neuropsychiatric disorders (e.g. cognitive disorders secondary to treatment, delirium) have been shown to affect an average of 30-35% patients, with differences according to stage and type of cancer. Also other psychosocial syndromes (e.g. demoralization, health anxiety, irritable mood) not taken into account in usual nosological systems should be considered for their impact on the patient's quality-of-life. Also, it has been repeatedly reported that psychological distress reverberates substantially throughout the nuclear family, and that a family approach is necessary in cancer care, with the caregiver-patient dyad as a unit to be the focus and direction of assessment and intervention. In this review the most significant psychosocial disorders causing burden for cancer patients and their caregivers are examined, and the main methods of assessment for more proper referral and treatment are summarized.
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Affiliation(s)
- Rosangela Caruso
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatric Unit , Program of Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior , S. Anna University Hospital and Health Authority , Ferrara , Italy
| | - Mara Giulia Nanni
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatric Unit , Program of Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior , S. Anna University Hospital and Health Authority , Ferrara , Italy
| | - Michelle B Riba
- c Department of Psychiatry , University of Michigan , Ann Arbor , MI , USA.,d University of Michigan Comprehensive Cancer Center , Ann Arbor , MI , USA.,e Psycho-oncology Program , University of Michigan Comprehensive Cancer Center , Ann Arbor , MI , USA
| | - Silvana Sabato
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy
| | - Luigi Grassi
- a Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences , University of Ferrara , Ferrara , Italy.,b University Hospital Psychiatric Unit , Program of Psycho-Oncology and Psychiatry in Palliative Care, Integrated Department of Mental Health and Addictive Behavior , S. Anna University Hospital and Health Authority , Ferrara , Italy
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9
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Caruso R, Nanni MG, Riba M, Sabato S, Mitchell AJ, Croce E, Grassi L. Depressive spectrum disorders in cancer: prevalence, risk factors and screening for depression: a critical review. Acta Oncol 2017; 56:146-155. [PMID: 28140731 DOI: 10.1080/0284186x.2016.1266090] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although depression and mood-related disorders are common in persons with cancer, these conditions remain frequently overlooked in clinical practice. Negative consequences of depressive disorder spectrum have been reported (e.g. suicidal ideation, increase physical complications and somatic symptoms, negative influence on prognosis), indicating the need for routine screening, assessment and management. METHODS A search of the major databases (Medline, Embase, PsycLIT, PsycINFO, and the Cochrane Library) was conducted on the reviews and meta-analyses available in order to summarize relevant data concerning depressive disorders spectrum in terms of prevalence, risk factors, and screening and assessment among patients with cancer across the trajectory of the disease. RESULTS The data show a prevalence of depression and depressive disorders between 5% and 60% according to the different diagnostic criteria, the tools used in the studies (e.g. semi-structured psychiatric interview and psychometric questionnaires), as well as the stage and type of cancer. Furthermore, despite the significant health care resources devoted to cancer care and the importance of addressing depressive symptoms, assessment and management of depressive spectrum disorders in cancer patients remains suboptimal. CONCLUSIONS Routine screening and adequate assessment of depressive spectrum disorders is necessary in patients with cancer in order to effectively manage the multifaceted and complex consequences on cancer care.
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Affiliation(s)
- R. Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - M. G. Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy
| | - M. Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA and University of Michigan Comprehensive Cancer Center, Ann, Arbor, MI, USA
- Psycho-oncology Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - S. Sabato
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - A. J. Mitchell
- Department of Psycho-oncology, University of Leicester and Leicestershire Partnership Trust, Leicester, UK
| | - E. Croce
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - L. Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Disorders, S. Anna University Hospital and Health Authorities, Ferrara, Italy
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10
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Liu Y, Liu F, Yu Y, Li Q, Jin X, Li J. Symptom Frequencies and Intensities in Hospitalized Patients With Advanced Cancer Having Depressive Disorder. Am J Hosp Palliat Care 2016; 34:456-460. [PMID: 27334800 DOI: 10.1177/1049909116655292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: To explore the frequencies and intensities of depressive symptoms associated with hospitalized patients with advanced cancer. Methods: A total of 196 hospitalized patients with advanced cancer were surveyed with the Edmonton Symptom Assessment System and Self-Rating Depression Scale (SDS). The χ2 test and Wilcoxon rank-sum test were used to compare the frequency and intensity of symptoms between patients with and without depressive disorders. Spearman rank correlation was used to test the correlation between depression and symptoms. Results: Of the 196 enrolled patients, 115 (59%) were males. The median age of the patients was 58 (19-80) years. Seventy-six (39%) patients were diagnosed with depression (SDS ≥ 53). Patients with depressive disorders exhibited pain, drowsiness, and nausea along with a higher frequency and intensity of poor self-perception, appetite loss, anxiety, dyspnea, and fatigue. Depressive symptoms were positively correlated with the symptoms. Conclusion: Depressive disorders are very common and severe in hospitalized patients with advanced cancer. Identifying the frequencies and intensities of the symptoms enables early intervention to improve patients’ quality of life.
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Affiliation(s)
- Yong Liu
- Department of Medical Oncology, Xuzhou Hospital Affiliated to Medical College of Southeast University and Xuzhou Central Hospital, Xuzhou, China
| | - Fei Liu
- Outpatient Department, Beihai Navy Fleet, Qingdao, China
| | - Yang Yu
- Department of Medical Oncology, Xuzhou Hospital Affiliated to Medical College of Southeast University and Xuzhou Central Hospital, Xuzhou, China
| | - Qing Li
- Department of Medical Oncology, Xuzhou Hospital Affiliated to Medical College of Southeast University and Xuzhou Central Hospital, Xuzhou, China
| | - Xin Jin
- Department of Medical Oncology, Xuzhou Hospital Affiliated to Medical College of Southeast University and Xuzhou Central Hospital, Xuzhou, China
| | - Jin Li
- Department of Surgical Oncology, Xuzhou Hospital Affiliated to Medical College of Southeast University and Xuzhou Central Hospital, Xuzhou, China
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Depression in advanced cancer--assessment challenges and associations with disease load. J Affect Disord 2015; 173:176-84. [PMID: 25462414 DOI: 10.1016/j.jad.2014.11.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patients with advanced cancer commonly experience multiple somatic symptoms and declining functioning. Some highly prevalent symptoms also overlap with diagnostic symptom-criteria of depression. Thus, assessing depression in these patients can be challenging. We therefore investigated 1) the effect of different scoring-methods of depressive symptoms on detecting depression, and 2) the relationship between disease load and depression amongst patients with advanced cancer. METHODS The sample included 969 patients in the European Palliative Care Research Collaborative-Computer Symptom Assessment Study (EPCRC-CSA). Inclusion criteria were: incurable metastatic/locally advanced cancer and ≥ 18 years. Biomarkers and length of survival were registered from patient-records. Depression was assessed using the Patient Health Questionnaire (PHQ-9) and applying three scoring-methods: inclusive (algorithm scoring including the somatic symptom-criteria), exclusive (algorithm scoring excluding the somatic symptom-criteria) and sum-score (sum of all symptoms with a cut-off ≥ 8). RESULTS Depression prevalence rates varied according to scoring-method: inclusive 13.7%, exclusive 14.9% and sum-score 45.3%. Agreement between the algorithm scoring-methods was excellent (Kappa = 0.81), but low between the inclusive and sum scoring-methods (Kappa = 0.32). Depression was significantly associated with more pain (OR-range: 1.09-1.19, p < 0.001-0.04) and lower performance status (KPS-score, OR-range = 0.68-0.72, p < 0.001) irrespective of scoring-method. LIMITATIONS Depression was assessed using self-report, not clinical interviews. CONCLUSIONS The scoring-method, not excluding somatic symptoms, had the greatest effect on assessment outcomes. Increasing pain and poorer than expected physical condition should alert clinicians to possible co-morbid depression. The large discrepancy in prevalence rates between scoring-methods reinforces the need for consensus and validation of depression definitions and assessment in populations with high disease load.
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12
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Abstract
OBJECTIVE Our study aimed at examining nurses' perceptions of depression in cancer patients and their role in its management. METHOD We employed questionnaire-based semi-directed interviews. Participants were asked to classify 22 symptoms (related and specific to depression in cancer patients, related but not specific, and unrelated) as "very important," "important," "less important," or "not important" for the diagnosis of depression in cancer patients at two different timepoints (baseline and after a video education program). They were also asked to complete a questionnaire exploring their perceptions about depression and of their role in its systematic screening. We recruited nurses caring for cancer patients from four different departments (palliative care unit, hematology, medical oncology, and thoracic oncology) at an academic medical center. RESULTS We interviewed 18 nurses and found that they had a good general knowledge of depression in cancer patients, with the majority of them being able to distinguish specific and important symptoms from nonspecific symptoms. Some nurses considered depression as a second-line symptom, and most did not employ a screening tool in their daily practice. All considered that they had a role to play in the management of depression, even as they acknowledged lacking specific training for that task. SIGNIFICANCE OF RESULTS Our results suggest that limited resources—especially lack of training—affects nurses' ability to correctly manage depression in their cancer patients.
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Abstract
Depression is a frequent problem in advanced cancer patients. However, there is no systematic screening for depression in the majority of cancer center resulting in underdiagnosed depression among cancer patients. The main objective of this study was to assess the level of agreement between self-reported depression by the patient and the physician and nurse assessment using the same tools. One of the secondary objectives was to estimate the possibility of a systematic and repeated (at one month) assessment. We used two scales for depression screening: the Brief Edinburg Depression Scale (BEDS) and the depression item of the Edmonton Symptom Assessment System (ESAS). Twenty-nine patients were included and eight of them (28%) had a BEDS score >6 and benefited from the initiation or modification of their antidepressant treatment. At visit 2, 15 patients were seen again and BEDS score was found ≤6 for all of them. A moderate concordance was found between assessment using the BEDS by patient and physician's (κ=0.519) and low agreement was found between physician and nurse regardless of the tool used (κ from 0.071 to 0.313). Researches with larger cohorts are now needed to confirm the benefits of depression's screening in this frail population and also to assess available strategies.
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Family caregivers' perceptions of depression in patients with advanced cancer: a qualitative study. Palliat Support Care 2014; 13:443-50. [PMID: 24524805 DOI: 10.1017/s1478951513001223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Depression is a serious issue for cancer patients, resulting in impaired quality of life and probably shorter survival. However, many cancer patients with depression are not treated because of the difficulties in identifying depression within this population. Our study aimed to examine caregivers' perceptions of depression among advanced cancer patients. METHOD This qualitative study employed semistructured interviews, and we analyzed data using grounded theory and qualitative methods. We recruited caregivers from our palliative care unit (PCU) at an academic medical center. RESULTS We interviewed a total of 15 caregivers. Cancer patients' caregivers had a good theoretical knowledge of depression but also acknowledged that, in the context of cancer and because of their relationship with the patient, identification of depressive symptoms could be challenging. They considered themselves as partners in the patient's care with a supportive role. However, by assuming the role of partner in patient care, caregivers exposed themselves to emotional difficulties and an increased need for support and information. SIGNIFICANCE OF RESULTS Our results suggest a significant impact of depression in advanced cancer caregivers, and it is therefore crucial that healthcare professionals develop educational programs targeting cancer patients' families as well as specific interventions to minimize the impact of the burden of patient care on caregivers.
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Depressive disorder in the last phase of life in patients with cardiovascular disease, cancer, and COPD: data from a 20-year follow-up period in general practice. Br J Gen Pract 2014; 63:e303-8. [PMID: 23643227 DOI: 10.3399/bjgp13x667150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Depression is assumed to be common in chronically ill patients during their last phase of life and is associated with poorer outcomes. The prevalence of depression is widely varying in previous studies due to the use of different terminology, classification, and assessment methods. AIM To explore the reported incidence of depressive disorder, as registered in the last phase of life of patients who died from cardiovascular disease, cancer or COPD, in a sample of primary care patients. DESIGN AND SETTING A historic cohort study, using a 20-year period registration database of medical records in four Dutch general practices (a dynamic population based on the Continuous Morbidity Registration database). METHOD Medical history of the sample cohort was analysed for the diagnosis of a new episode of depressive disorder and descriptive statistics were used. RESULTS In total 982 patients were included, and 19 patients (1.9%) were diagnosed with a new depressive disorder in the last year of their life. The lifetime prevalence of depressive disorder in this sample was 8.2%. CONCLUSION The incidence of depressive disorder in the last phase of life is remarkably low in this study. These data were derived from actual patient care in general practice. Psychiatric diagnoses were made by GPs in the context of both patient needs and delivered care. A broader concept of depression in general practice is recommended to improve the diagnosis and treatment of mood disorders in patients in the last phase of life.
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Porche K, Reymond L, Callaghan JO, Charles M. Depression in palliative care patients: a survey of assessment and treatment practices of Australian and New Zealand palliative care specialists. AUST HEALTH REV 2014; 38:44-50. [DOI: 10.1071/ah13041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 09/30/2013] [Indexed: 11/23/2022]
Abstract
Objective To explore the practices of members of the Australian and New Zealand Society of Palliative Medicine (ANZSPM) in assessing and treating depression in palliative care patients. Methods Semistructured questionnaires were forwarded to ANZSPM members in consecutive mail-outs to survey diagnostic and treatment practices for depression. Results The response rate was 62.3%. The median prevalence of depression, as perceived by respondents, in the present respondent patient populations was 20% (range 0%–90%); 57.1% of respondents always assessed for depression, whereas 42.9% assessed for depression sometimes. The majority (98.9%) of respondents relied on clinical interviews to assess depression; non-somatic symptoms of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria were more useful than somatic symptoms. The depression screening tools most frequently used were one- and two-item questions. Pharmacological and non-pharmacological methods were used to treat depression, with selective serotonin reuptake inhibitors the most frequently prescribed medications. Psycho-educational and supportive counselling were the most frequently used non-pharmacological interventions. Nominated measures to augment depression management included improving access to psychiatry, psychology and other allied health services, the development of a screening tool specific to palliative care patients and associated guidelines for depression management. Conclusions This is the first Australasian study to explore the practice of medical practitioners regarding depression in palliative patients. Incorporation of screening tool questions into palliative care assessment interviews may warrant future research. What is known about the topic? Depression in palliative care patients has a negative impact on quality of life; however, little is known about how Australasian palliative care medical practitioners manage depression in this patient population. What does this paper add? To the researchers’ knowledge, this is the first Australasian study that explores the practices of local palliative care specialists in the management of depression in palliative patients. What are the implications for practitioners? Overall management of depression in palliative care populations by Australasian practitioners is similar to that of their European colleagues. Consensus is that for assessment of depression in palliative patients, non-somatic symptoms of DSM-IV criteria are more useful than somatic symptoms. Practitioners report the need for improved access to psychiatric, psychological and other support services, for a palliative care-specific depression screening tool and for depression management guidelines applicable to palliative care patients.
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Laoutidis ZG, Mathiak K. Antidepressants in the treatment of depression/depressive symptoms in cancer patients: a systematic review and meta-analysis. BMC Psychiatry 2013; 13:140. [PMID: 23679841 PMCID: PMC3674917 DOI: 10.1186/1471-244x-13-140] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 04/09/2013] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Over the past thirty years a number of studies have suggested that antidepressants can be effective in the treatment of depressive symptoms in patients with cancer. The aim of this paper was to review randomized controlled trials (RCTs) and to perform a meta-analysis in order to quantify their overall effect. METHODS Pubmed and the Cochrane libraries were searched for the time period between 1980 and 2010. RESULTS Nine RCTs were identified and reviewed. Six of them (with a total of 563 patients) fulfilled the criteria for meta-analysis, but exhibited an unclear risk for bias. The estimated effect size was 1.56 with 95% CI: 1.07- 2.28 (p= 0.021). There were no differences in discontinuation rates between antidepressants and placebo groups (RR= 0.86 with 95% CI 0.47- 1.56, p=0.62). CONCLUSIONS This meta-analysis suggests that antidepressants can be effective in treating depressive symptoms beside clinical depression. When considering the risk of side effects and interactions and the heterogeneity among the mostly small studies, a general recommendation cannot be made until well-controlled studies are conducted.
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Affiliation(s)
- Zacharias G Laoutidis
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH, University of Aachen, Bergische Landstrasse 2, 40629 Düsseldorf, Germany.
| | - Klaus Mathiak
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH University of Aachen, Bergische Landstrasse 2, 40629 Düsseldorf, Germany,Jülich Aachen Research Alliance (JARA-BRAIN), Pauwelstrasse 30, Aachen, 52074, Germany,Institute of Neuroscience and Medicine (INM-1), Forschungszentrum Jülich GmbH, Aachen, Germany
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Warmenhoven F, van Weel C, Vissers K, Prins J. Screening Instruments for Depression in Advanced Cancer Patients: What Do We Actually Measure? Pain Pract 2012; 13:467-75. [DOI: 10.1111/papr.12012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Franca Warmenhoven
- Department of Primary and Community Care; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
| | - Judith Prins
- Department of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen; The Netherlands
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Woitha K, Van Beek K, Ahmed N, Hasselaar J, Mollard JM, Colombet I, Radbruch L, Vissers K, Engels Y. Development of a set of process and structure indicators for palliative care: the Europall project. BMC Health Serv Res 2012; 12:381. [PMID: 23122255 PMCID: PMC3529116 DOI: 10.1186/1472-6963-12-381] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 10/31/2012] [Indexed: 01/27/2023] Open
Abstract
Background By measuring the quality of the organisation of palliative care with process and structure quality indicators (QIs), patients, caregivers and policy makers are able to monitor to what extent recommendations are met, like those of the council of the WHO on palliative care and guidelines. This will support the implementation of public programmes, and will enable comparisons between organisations or countries. Methods As no European set of indicators for the organisation of palliative care existed, such a set of QIs was developed. An update of a previous systematic review was made and extended with more databases and grey literature. In two project meetings with practitioners and experts in palliative care the development process of a QI set was finalised and the QIs were categorized in a framework, covering the recommendations of the Council of Europe. Results The searches resulted in 151 structure and process indicators, which were discussed in steering group meetings. Of those QIs, 110 were eligible for the final framework. Conclusions We developed the first set of QIs for the organisation of palliative care. This article is the first step in a multi step project to identify, validate and pilot QIs.
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Affiliation(s)
- Kathrin Woitha
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Geert Grote Plein 10, Nijmegen 6500 HB, The Netherlands.
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Goodwin L, Lee W, Price A, Rayner L, Monroe B, Sykes N, Hansford P, Higginson IJ, Hotopf M. Predictors of non-remission of depression in a palliative care population. Palliat Med 2012; 26:683-95. [PMID: 21697262 DOI: 10.1177/0269216311412230] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Prospective studies of depression in palliative care are rare. Two studies that examine depression prospectively in patients with advanced disease have not looked at predictors of remission. AIMS to explore prospective predictors of non-remission of depression in palliative care. DESIGN AND PARTICIPANTS The study design comprised two data collections: initial assessment on referral to a palliative care service in South London, UK, and a four-week follow-up. Seventy six participants met the criteria for 'any depressive syndrome' at the time 1 assessment, using the PRIME-MD, who also participated at time 2. The outcome measure was remission (N = 39) or non-remission (N = 37) of depression by time 2. RESULTS The findings showed that reporting low social support from family and friends at time of referral was the most powerful risk factor for non-remission. There was also a strong association between improved physical symptoms, from time 1 to 2, and remission of depression. CONCLUSIONS This study in palliative care is the first of which we are aware to explore factors associated with non-remission of depression. Depressed patients identified with low social support on referral to palliative care services might particularly benefit from additional psychosocial care in the treatment of their depression. This study provides evidence that effective physical symptom management in palliative care may be a valuable intervention for depressive symptoms.
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Affiliation(s)
- Laura Goodwin
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK.
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21
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Warmenhoven F, van Rijswijk E, van Hoogstraten E, van Spaendonck K, Lucassen P, Prins J, Vissers K, van Weel C. How family physicians address diagnosis and management of depression in palliative care patients. Ann Fam Med 2012; 10:330-6. [PMID: 22778121 PMCID: PMC3392292 DOI: 10.1370/afm.1373] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 09/29/2011] [Accepted: 10/17/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Depression is highly prevalent in palliative care patients. In clinical practice, there is concern about both insufficient and excessive diagnosis and treatment of depression. In the Netherlands, family physicians have a central role in delivering palliative care. We explored variation in family physicians' opinions regarding the recognition, diagnosis, and management of depression in palliative care patients. METHODS We conducted a focus group study in a sample of family physicians with varied practice locations and varying expertise in palliative care. Transcripts were analyzed independently by 2 researchers using constant comparative analysis in ATLAS.ti. RESULTS In 4 focus group discussions with 22 family physicians, the physicians described the diagnostic and therapeutic process for depression in palliative care patients as a continuous and overlapping process. Differentiating between normal and abnormal sadness was viewed as challenging. The physicians did not strictly apply criteria of depressive disorder but rather relied on their clinical judgment and strongly considered patients' context and background factors. They indicated that managing depression in palliative care patients is mainly supportive and nonspecific. Antidepressant drugs were seldom prescribed. The physicians described difficulties in diagnosing and treating depression in palliative care, and gave suggestions to improve management of depression in palliative care patients in primary care. CONCLUSIONS Family physicians perceive the diagnosis and management of depression in palliative care patients as challenging. They rely on open communication and a long-standing physician-patient relationship in which the patient's context is of great importance. This approach fits with the patient-centered care that is promoted in primary care.
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Affiliation(s)
- Franca Warmenhoven
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands.
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22
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Hallford DJ, McCabe MP, Mellor D, Davison TE, Goldhammer DL. Depression in palliative care settings: the need for training for nurses and other health professionals to improve patients' pathways to care. NURSE EDUCATION TODAY 2012; 32:556-560. [PMID: 21862185 DOI: 10.1016/j.nedt.2011.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/25/2011] [Accepted: 07/28/2011] [Indexed: 05/31/2023]
Abstract
Depression is highly prevalent in patients receiving palliative care; however, detection rates are low, with many patients who suffer with depression continuing to go undetected and untreated. A number of factors unique to this setting, as well as issues relating to staff knowledge and self-efficacy working with depression, may impede the detection of patients who are depressed by professional health care staff. Although programmes aimed to train nurses and other allied health staff in depression may be an effective way to improve detection rates, there have been few studies investigating the efficacy of these interventions. This article draws upon recent literature to provide a narrative review of barriers to detection and factors relating to professional palliative care staffs' ability to provide pathways to care for patients who suffer with depression in this setting. Previously evaluated training programmes are reviewed and the argument is made that further development and empirical evaluation of depression training interventions for staff in this setting will provide services with evidence-based methods of training nurses and other professional care staff and improve the pathways to care for patients who suffer with depression.
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Abstract
AbstractObjective:Depression is a frequent problem in cancer patients, which is known to reduce quality of life; however, many cancer patients with depression are not treated because of the difficulties in assessing depression in this population. Our aim was to evaluate and improve the depression assessment strategies of palliative care (PC) physicians and oncologists.Method:We invited all medical oncologists and PC physicians from three cancer centers to participate in this multicenter prospective study. They were asked to classify 22 symptoms (related and specific to depression in cancer patients, related but not specific, and unrelated) as “very important,” “important,” “less important,” or “not important” for the diagnosis of depression in cancer patients, at three different time points (at baseline, after a video education program, and after 4 weeks). They were also asked to complete a questionnaire exploring physicians' perceptions of depression and of their role in its systematic screening.Results:All 34 eligible physicians participated. Baseline performance was good, with >70% of participants correctly classifying at least seven of nine related and specific symptoms. We found no significant improvement in scores in the immediate and 4-week follow-up tests. Additionally, 24 (83%) and 23 (79%) participants expressed support for systematic depression screening and a role for oncologists in screening, respectively.Significance of results:Oncologists had good baseline knowledge about depression's main symptoms in cancer patients and a positive attitude toward being involved in screening. Underdiagnosis of depression is probably related to problems associated with the oncology working environment rather than the physicians' knowledge.
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McCabe MP, Mellor D, Davison TE, Hallford DJ, Goldhammer DL. Detecting and Managing Depressed Patients: Palliative Care Nurses' Self-Efficacy and Perceived Barriers to Care. J Palliat Med 2012; 15:463-7. [DOI: 10.1089/jpm.2011.0388] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Antidepressants to cancer patients during the last year of life-a population-based study. Psychooncology 2012; 22:506-14. [DOI: 10.1002/pon.3059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/31/2012] [Accepted: 02/06/2012] [Indexed: 11/07/2022]
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Low prevalence of depressive disorder in ambulatory advanced cancer patients using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1). J Affect Disord 2012; 136:1209-11. [PMID: 22154709 DOI: 10.1016/j.jad.2011.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 11/17/2011] [Accepted: 11/17/2011] [Indexed: 11/23/2022]
Abstract
Depressive disorder is assumed to be highly prevalent in advanced cancer patients, but the diagnosis of depressive disorder in patients with advanced cancer is difficult. The more robust the assessment instrument to diagnose depressive disorder is, the lower the reported prevalence of depressive disorder in advanced cancer patients. This study confirms a low prevalence of depressive disorder (3%) in 64 advanced cancer outpatients using a robust structured clinical assessment (SCAN 2.1). Furthermore, in this article we discuss possible implications of using predefined psychiatric labeling in the assessment of mood symptoms in advanced cancer patients.
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Ruijs CDM, Kerkhof AJFM, van der Wal G, Onwuteaka-Philipsen BD. Depression and explicit requests for euthanasia in end-of-life cancer patients in primary care in the Netherlands: a longitudinal, prospective study. Fam Pract 2011; 28:393-9. [PMID: 21421745 DOI: 10.1093/fampra/cmr006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In the Netherlands, many (45%) cancer patients die at home, in the care of GPs. About 1 out of 10 end-of-life cancer deaths is hastened by GPs through euthanasia or physician-assisted suicide. However, the relationship between depression and requests for euthanasia has never been prospectively studied directly in primary care. OBJECTIVE This study aimed to assess the prevalence of depression in end-of-life cancer patients requesting euthanasia in primary care, as well as to assess the relationship between depression and requesting euthanasia. METHODS Primary care patients with incurable cancer and an estimated life expectancy of half a year or shorter were interviewed every 2 months, using standardized psychometric instruments. Also, non-recruited eligible patients were monitored. RESULTS Out of 258 eligible patients, 76 patients were recruited, of whom 64 patients were followed up until death. Of these, 27% (n = 17) explicitly requested euthanasia. One patient suffered from major depression. According to the depression subscale of the Hospital Anxiety and Depression Scale, 47% of the patients who explicitly requested euthanasia versus 28% of those without an euthanasia request suffered from a depressed mood at inclusion; the difference was not significant (P = 0.2). Corresponding figures for the last interview before death were 40% and 41% (P = 0.6). CONCLUSIONS Major depression was not a major factor in explicit requests for euthanasia in end-of-life cancer patients in primary care. Further depressed mood was not associated with explicitly requesting euthanasia in this patient group, although statistical underpower cannot be ruled out in this small sample.
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Abstract
Palliative care is not just vital in controlling symptoms of the patient’s disease condition, but also aims to extend the patient’s life, giving it a better quality. However, several times in the course of management, the psychosocial impact of cancer, HIV/AIDS, and other life-limiting disease conditions may not be noticed and dealt with during the admission period, thereby giving rise to a more complex situation than the disease condition itself. This article aims to review some psychosocial issues and measures that can be taken to address them. It highlights the various roles and the importance of the clinician, nurse, social worker, and other members of the multidisciplinary team in tackling these issues and will help healthcare professionals in this field achieve better practice in the future.
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Affiliation(s)
- Tonia C Onyeka
- Department of Anesthesia, Pain and Palliative Care Unit, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, PMB 01129, Nigeria
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Gao W, Stark D, Bennett MI, Siegert RJ, Murray S, Higginson IJ. Using the 12-item General Health Questionnaire to screen psychological distress from survivorship to end-of-life care: dimensionality and item quality. Psychooncology 2011; 21:954-61. [PMID: 21557386 DOI: 10.1002/pon.1989] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study aimed (i) to determine the factor structure of the 12-item General Health Questionnaire (GHQ-12) across the cancer trajectory represented by samples from three cancer care settings and (ii) to appraise the item misfit and differential item functioning (DIF) of the GHQ-12. DATA AND METHODS Data were from cancer outpatient (n = 200), general community (n = 364) and palliative care (n = 150) settings. The factor structure was tested using exploratory factor analysis followed by confirmatory factor analysis. The factors were assessed for correlation using Spearman's ρ. The analyses were run separately for standard GHQ, Likert, modified Likert and chronic GHQ scoring and for the individual cancer settings. The best scoring method within the cancer setting was determined by Akaike's information criterion (AIC). Item misfit (mean square, MNSQ; standardised z-score, ZSTD) and DIF were assessed using the Rasch model. RESULTS The best scoring method was the chronic GHQ for the cancer outpatient (AIC = -45.8), modified Likert for the general community (AIC = 9.6) and standard GHQ for the palliative care (AIC = -43.0). The GHQ-12 displayed a correlated two-factor structure ('social dysfunction' and 'distress'); Spearman ρ values were 0.69, 0.82 and 0.88 in the cancer outpatient, the general community and the palliative care, respectively. One item in the palliative care indicated misfit (MNSQ = 1.62, ZSTD = 3.0). Five items in the cancer outpatient showed DIF by gender and age. Two items in the palliative care showed DIF by gender. CONCLUSIONS The GHQ-12 was more problematic (less clear factor structure and evidence of item bias) for newly diagnosed patients, less problematic for patients approaching end-of-life and satisfactory for patients between those times.
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Affiliation(s)
- Wei Gao
- Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, School of Medicine, King's College London, King's Healthcare Partners, London, UK
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Rayner L, Lee W, Price A, Monroe B, Sykes N, Hansford P, Higginson IJ, Hotopf M. The clinical epidemiology of depression in palliative care and the predictive value of somatic symptoms: cross-sectional survey with four-week follow-up. Palliat Med 2011; 25:229-41. [PMID: 21228092 DOI: 10.1177/0269216310387458] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This cross-sectional survey aimed to determine the prevalence and remission of depression in patients receiving palliative care and to ascertain the predictive value of somatic symptoms in making the diagnosis. Three hundred consecutive patients were interviewed within one week of their initial assessment by a specialist nurse at a palliative care service with in-patient and homecare facilities in south London, UK. Depression was assessed using the PRIME-MD PHQ-9. Presence of somatic symptoms (fatigue, sleep disturbance, poor appetite) was determined using the EORTC-QLQ-C30 quality of life questionnaire. Fifty-eight (19.3% [15.3 to 23.3]) patients met criteria for Major Depressive Disorder; 109 (36.3% [32.3 to 40.3]) met criteria for 'Any depressive syndrome'. Patients with Major Depressive Disorder were more likely to be male, and to have non-malignant disease, pain, poor performance status and desire for an early death. Of those patients with Major Depressive Disorder at baseline, 69% (27/39) had remitted four weeks later. Of those not depressed at baseline, 11% (19/174) met criteria for depression at follow-up. The positive predictive values of sleep disturbance, poor appetite and fatigue were low (<24%), whereas the negative predictive values of these symptoms were high (>89%). The high prevalence of depression in palliative care attests to the need for psychological assessment and support. Depression in patients receiving palliative care is unstable, suggesting that symptoms should be carefully monitored.
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Affiliation(s)
- Lauren Rayner
- King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, UK.
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The development of evidence-based European guidelines on the management of depression in palliative cancer care. Eur J Cancer 2011; 47:702-12. [DOI: 10.1016/j.ejca.2010.11.027] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 11/18/2010] [Accepted: 11/26/2010] [Indexed: 11/19/2022]
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Rayner L, Price A, Evans A, Valsraj K, Hotopf M, Higginson IJ. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med 2011; 25:36-51. [PMID: 20935027 DOI: 10.1177/0269216310380764] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression can exacerbate symptoms associated with life-threatening illness and increase disability and distress. In palliative care, depression occurs in a context of multiple symptoms, which complicates detection and treatment. While systematic reviews of antidepressants have been conducted in specific life-threatening diseases, no previous study has synthesized the evidence in palliative care. The objective of this study was to determine the efficacy of antidepressants for the treatment of depression in palliative care. MEDLINE, EMBASE, PSYCINFO and Cochrane trials registers were systematically searched to identify randomized controlled trials comparing antidepressants and placebo for the treatment of depression in palliative care. The primary outcome was efficacy assessed at three time-points. Twenty-five studies were included in the review. At each time-point antidepressants were more efficacious than placebo: 4-5 weeks odds ratio (OR) 1.93 (1.15-3.42) p = 0.001; 6-8 weeks OR 2.25 (1.38-3.67) p = 0.001; 9-18 weeks OR 2.71 (1.50-4.91) p = 0.001. This review provides evidence that antidepressants are effective in treating depression in palliative care. Their superiority over placebo is apparent within 4-5 weeks and increases with continued use. It is probable that the effect sizes yielded in this review overestimate the efficacy of antidepressants due to biases such as selective reporting and publication. Nevertheless, the magnitude and consistency of the effect suggests genuine benefit.
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Affiliation(s)
- Lauren Rayner
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, UK.
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Gao W, Bennett MI, Stark D, Murray S, Higginson IJ. Psychological distress in cancer from survivorship to end of life care: prevalence, associated factors and clinical implications. Eur J Cancer 2010; 46:2036-44. [PMID: 20447824 DOI: 10.1016/j.ejca.2010.03.033] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 03/25/2010] [Indexed: 11/27/2022]
Abstract
AIMS Understanding how psychological distress changes over the cancer trajectory is essential to target interventions and care, but is little researched because of difficulties in conducting longitudinal studies. We aimed to determine the prevalence of psychological distress, its associated factors and clinical implications at three different stages in the cancer trajectory. DATA AND METHODS Cancer patients from cancer outpatients (n=200), the general community (n=364) and specialist palliative care (n=150) were included. Psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12). Associated factors and clinical prognostic value were investigated using logistic regression and Cox regression. RESULTS Overall prevalence of psychological distress was 24.5% (95% CI: 18.5-30.5%) in cancer outpatients during or soon after treatment, 16.5% (95%CI: 12.7-20.3%) in the general community and rose to 59.3% (95%CI: 51.4-67.2%) in specialist palliative care. Cancer type was the best predictor for psychological distress in both specialist palliative care (PR(prostate cancer versus other cancers)=5.61; 95%CI: 1.21-26.04; p=0.008) and general community samples (PR(lung cancer versus other cancers)=3.64; 95%CI: 1.08-12.35; p=0.003). Higher scores on GHQ-12 items predicted shorter survival in palliative care patients and showed weak protective or no association with survival in cancer outpatients. CONCLUSION Patients undergoing oncological treatment and then again as they approaching death have increased levels of psychological distress. Assessing psychological distress through survivorship and especially at these times may identify unmet psychological needs and allow targeted psychological support.
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Affiliation(s)
- Wei Gao
- King's College London, Department of Palliative Care, Policy and Rehabilitation, King's Healthcare Partners, Weston Education Centre, 3rd Floor, Cutcombe Road, Denmark Hill, London SE5 9RJ, United Kingdom
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Evolving classification systems for cancer cachexia: ready for clinical practice? Support Care Cancer 2010; 18:273-9. [DOI: 10.1007/s00520-009-0800-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 12/08/2009] [Indexed: 11/25/2022]
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