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Depression in cancer patients is a serious comorbidity that negatively affects quality of life, immune response, prognosis, and overall survival. Approximately 10% to 25% of cancer patients experience depression, a rate four times higher than that of the general population. Several factors contribute to mood disturbances and the potential for major depression in cancer patients, including fear, treatment effects, physical pain, and financial concerns. Although timely recognition and treatment of depression is a standard of care recommended by the National Comprehensive Cancer Network, studies across all clinical settings show that few patients are screened for depressive symptoms.

Analyzing Depression Screening Rates

Treating depression can help prevent adverse outcomes and improve quality of life in cancer patients. However, screening opportunities are often compromised by competing clinical demands and beliefs that depression is to be expected or untreatable. My colleagues and I recently examined depression screening practices at a VA hospital to determine if there were any disparities in depression screening rates among cancer patients when compared with a general population of veterans without cancer. Our findings, published in the November/December 2007 issue of General Hospital Psychiatry, demonstrated that veterans with cancer were significantly less likely to be screened for depression. Results from our 5-year study underscore the need for better screening of depression in newly diagnosed cancer patients.

Although screening for depression among veterans with cancer improved by 39% between 2000 and 2003 in our investigation, screening rates were still well below those at VA hospitals nationwide. Several reasons may explain these lower rates:

• Competing clinical demands tend to focus clinicians’ attention on medical symptoms versus psychiatric concerns.

• Clinicians may not feel that depression screening is worthwhile among terminally ill cancer patients who are expected to survive only a few months.

• Treatment of cancer-related conditions (eg, pain and fatigue) may receive priority over depression.

Seize the Opportunity

Because depression can surface at different points during diagnosis and treatment for cancer, depression screening should be considered part of an ongoing targeted quality improvement initiative for all patients, including those with advanced cancer. Nationally recognized depression screening instruments—including the Patient Health Questionnaire-2, the Beck Depression Inventory, and the Center for Epidemiologic Studies Depression Scale—are standardized tools that are readily available for clinical use. These screenings require only a few minutes of the clinician’s time and may be as simple as asking patients a few questions about depression and addressing concerns during the clinical encounter. Given the severity of depression and/or clinical time constraints, scheduling follow-up visits or referring patients to mental health specialists may be appropriate.

Screening for depression is not only feasible and efficacious, but it can also be cost-effective. The serious, debilitating effects of depression are treatable, and benefits can occur quickly, if not immediately. Patients who are appropriately treated for depression with antidepressants had better cancer outcomes, including survival. Clinicians should also recognize that there are opportunities for future interventions, including expansion of routine depression screening into oncology care and improved technology to reduce screening failures in primary care settings.

Laura E. Jones, PhD, MSc, has indicated to Physician’s Weekly that she has received grants/research aid from the VA Health Services Research & Development.