For Cancer Patients, Depression Treatment Improves QoL But Not Survival

04/06/18

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - In patients with cancer who are depressed, a targeted treatment program improves depression and quality of life but does not extend life, according to new research from the U.K.

Cancer patients who are depressed have worse survival than those who are not, but it had been unclear if treating the depression would have an effect on mortality.

"The intensive management of depression in people with cancer is highly effective in improving quality of life," Dr. Michael Sharpe of the University of Oxford told Reuters Health by email. "This alone is good enough reason to improve our efforts to prioritize our treatment of depression in cancer patients. In other words, it’s not just how much life we give our patients, but what quality of life we give them."

For their study, online March 12 in The Lancet Psychiatry, Dr. Sharpe and his colleagues conducted a long-term follow-up of participants with comorbid cancer and major depression in the SMaRT Oncology-2 and 3 trials, which were done at three centers in Scotland.

The 500 participants in the former trial had good-prognosis cancers, while the 142 in the latter had lung cancer. In both studies, half the patients were randomly assigned to receive usual care and half to receive treatment with both pharmacological and psychological components.

The researchers followed participants in SMaRT Oncology-2 for a median of five years and those in SMaRT Oncology-3 for one year. Over this time, 27% of SMaRT Oncology-2 participants and 80% of SMaRT Oncology-3 participants died.

There was no significant effect of treatment on survival for either SMaRT Oncology-2 (hazard ratio, 1.02; P=0.93) or SMaRT Oncology-3 (HR, 0.82; P=0.28; pooled HR, 0.92; P=0.51).

Dr. Alex J. Mitchell of the University of Leicester, U.K., writes in a linked editorial that the research team “cannot be criticized for their low sample size or short follow-up. This study is a secondary analysis of a study designed to answer a different question: is depression care effective for alleviating depression after cancer?"

Dr. Vineeth John, director of geriatric psychiatry at the McGovern Medical School of the University of Texas in Houston, told Reuters Health by phone, "Quite often you read about the impact of adequately treated depression improving survival, not only in cancer, but in other illnesses as well. Once you adequately treat depression, survival is also improved. The fact that this study did not find improved survival was a surprise."

Dr. John, who was not involved in the study, cautioned, "If someone absorbs the results of the study and does not think through the study's limitations or what the study may not have totally addressed, some providers could take these results and underplay the need for aggressive treatment for depression in patients with cancer. What one might call therapeutic nihilism could set in."

"Despite the study findings," he added, "early and appropriate aggressive treatment of depression is key to enhancing the quality of life of patients with cancer and can also positively impact their prognosis."

Dr. Christina Pozo-Kaderman, director of clinical operations at Sylvester Comprehensive Cancer Center at the University of Miami Health System in Florida, said, "While these researchers were able to do an amazing job in setting this study up, the sample size was small and many patients were lost for follow-up. In addition, the follow-up was not very long."

"This study does not mention whether patients had a prior history of depression or were first diagnosed with depression when diagnosed with cancer," Dr. Pozo-Kaderman told Reuters Health by email. "Maybe only those with a prior history of depression have poorer survival? Nor does the study say anything about controlling for type of lung cancer or new available treatments."

Even so, she noted, "This study is important because it is a first step to start looking at the possible association of depression treatment and survival in these patients."

The study did not have commercial funding and the researchers report no conflicts if interest.

SOURCE: https://bit.ly/2H2Xm7R and https://bit.ly/2pWj6Li

Lancet Psychiatry 2018.

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