A B S T R A C T PurposeTo determine the effectiveness of the Alleviating Depression Among Patients With Cancer (ADAPt-C) collaborative care management for major depression or dysthymia. Patients and MethodsStudy patients included 472 low-income, predominantly female Hispanic patients with cancer age Ն 18 years with major depression (49%), dysthymia (5%), or both (46%). Patients were randomly assigned to intervention (n ϭ 242) or enhanced usual care (EUC; n ϭ 230). Intervention patients had access for up to 12 months to a depression clinical specialist (supervised by a psychiatrist) who offered education, structured psychotherapy, and maintenance/relapse prevention support. The psychiatrist prescribed antidepressant medications for patients preferring or assessed to require medication. ResultsAt 12 months, 63% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline as assessed by the Patient Health Questionnaire-9 (PHQ-9) depression scale compared with 50% of EUC patients (odds ratio [OR] ϭ 1.98; 95% CI, 1.16 to 3.38; P ϭ .01). Improvement was also found for 5-point decrease in PHQ-9 score among 72.2% of intervention patients compared with 59.7% of EUC patients (OR ϭ 1.99; 95% CI, 1.14 to 3.50; P ϭ .02). Intervention patients also experienced greater rates of depression treatment (72.3% v 10.4% of EUC patients; P Ͻ .0001) and significantly better quality-of-life outcomes, including social/family (adjusted mean difference between groups, 2.7; 95% CI, 1.22 to 4.17; P Ͻ .001), emotional (adjusted mean difference, 1.29; 95% CI, 0.26 to 2.22; P ϭ .01), functional (adjusted mean difference, 1.34; 95% CI, 0.08 to 2.59; P ϭ .04), and physical well-being (adjusted mean difference, 2.79; 95% CI, 0.49 to 5.1; P ϭ .02). ConclusionADAPt-C collaborative care is feasible and results in significant reduction in depressive symptoms, improvement in quality of life, and lower pain levels compared with EUC for patients with depressive disorders in a low-income, predominantly Hispanic population in public sector oncology clinics.

Purpose-To assess the prevalence of depression among low-income, ethnic minority women with breast or gynecological cancer, receipt of antidepressant medications or counseling services, and correlates of depression.Patients and Methods-Study patients were 472 women receiving cancer care in an urban public medical center. Women had a primary diagnosis of breast (Stage 0-III) or gynecological cancer (FIGO 0-3B). A diagnostic depression screen and baseline questionnaire was administered prior to or during active treatment or during active follow-up. Self-report data was collected on receipt of depression treatment, use of supportive counseling, pain and receipt of pain medication, functional status and well-being, and perceived barriers to cancer care.Results-Twenty-four percent of women reported moderate to severe levels of depressive disorder, 30% of breast cancer patients and 17% of gynecological cancer patients. Only 12% of women meeting criteria for major depression reported currently receiving medications for depression and only 5% of women reported seeing a counselor or participating in a cancer support group. Neither cancer stage or treatment status was correlated with depression. Primary diagnosis of breast cancer, younger age, greater functional impairment, poorer social/family well-being, anxiety, comorbid arthritis, and fears about treatment side effects were correlated with depression.Conclusion-Findings indicate that depressive disorder among ethnic minority, low-income women with breast or gynecological cancer is prevalent and is correlated with pain, anxiety and health-related quality of life (HRQL). Because these women are unlikely to receive depression treatment or supportive counseling, there is a need for routine screening, evaluation and treatment in this population.