Insufficient evidence to recommend first line treatment for depression in cancer patients


Depression is at least three times as common in patients with cancer compared to the rest of the population. Studies show that major depression occurs in 16% of cancer patients, with combined minor depression and dysthymia reported in 22% of people with cancer. Depression also appears to be more prevalent amongst people with certain cancers (pancreatic, gastric, oropharyngeal and lung).

Managing and treating different types of depression in this population is often complex, but recent research has demonstrated that psychosocial and drug treatments are safe and effective in this group.

This new review from researchers at the University of Toronto summarises the psychosocial and pharmacologic treatment of depression in patients with cancer based on a consideration of evidence regarding etiologic factors and treatment outcomes. The authors refer to a number of systematic reviews, meta-analyses and original studies in their summary.

They highlight the diagnostic ambiguity that exists for people with cancer and suspected depression. Many of the symptoms of depression overlap with the symptoms of cancer (tiredness, insomnia, cognitive impairment, eating disorders) and this can make it difficult to detect depression using standard tests.

The review highlights a number of issues relating to treatment of depression in cancer patients, but the authors conclude by saying:

Both psychosocial and pharmacologic interventions have been shown to be efficacious in treating depression in cancer, but further research is needed to establish their relative and combined benefit.

Future research directions include the development and evaluation of novel interventions targeted to specific biologic and psychosocial risk factors.

The review also mentions new and emerging treatments that show promise in this population, including:

  • Interventions that combine individually tailored psychosocial and pharmacologic approaches
  • Geriatric-specific group psychoeducational interventions
  • CALM (Cancer and Living Meaningfully) for patients with metastatic cancer
  • Dignity Therapy for patients near the end of life

Li M, Fitzgerald P, Rodin G. Evidence-Based Treatment of Depression in Patients With Cancer. J Clin Oncol. 2012 Mar 12. [Epub ahead of print] [Abstract]

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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