Depression assessment and classification in palliative cancer patients: a systematic literature review

Abstract

The objective of this study was to review the literature on depression in palliative cancer care in order to identify which assessment methods and classification systems have been used in studies of depression. Extensive electronic database searches in PubMed, CancerLit, CINAHL, PsychINFO, EMBASE and AgeLine as well as hand search were carried out. In the 202 included papers, 106 different assessment methods were used. Sixty-five of these were only used once. All together, the Hospital Anxiety and Depression Scale (HADS) was the most commonly used assessment method. However, there were regional differences and while the HADS dominated in Europe it was quite seldom used in Canada or in the USA. Few prevalence and intervention studies used assessment methods with an explicit reference to a diagnostic system. There were in total few case definitions of depression. Among these, the classifications were in general based on cut-off scores (77%) and not according to diagnostic systems. The full range of the DSM-IV diagnostic criteria was seldom assessed, i.e. less than one-third of the assessments in the review took into account the duration of symptoms and 18% assessed consequences and impact upon patient functioning. A diversity of assessment methods had been used. Few studies classified depression by referring to a diagnostic system or by using cut-off scores. Evidently, there is a need for a consensus on how to assess and conceptualize depression and related conditions in palliative care.

Enhancing patient-reported outcome measurement in research and practice of palliative and end-of-life care

“…Patient-reported outcome measurement (PROMs) play an increasing role in palliative and end-of-life (EOL) care but their use in EOL care and research remains varied and inconsistent, with often diverse measures being used once or twice only [1][2][3]. EOL care faces various complexities influencing the measurement of outcomes: (i) patients may report multiple symptoms rather than one problem, (ii) problems and symptoms are often complex (e.g., fatigue and spiritual problems), and (iii) patients go through different stages in their disease trajectory including the experience of deterioration at the end of life, with changing priorities and reduced physical and cognitive function [4].…”

The Edmonton Symptom Assessment System: Poor performance as screener for major depression in patients with incurable cancer

“…Most tools assessing multiple symptoms include one or more items on depression symptoms. The second most applied assessment of depression in palliative care research is the Edmonton Symptom Assessment System (ESAS) that includes nine simple items on frequent symptoms (21,22).…”

“…The EPCRC project aimed to improve assessment and classification of depression, pain and cachexia in patients with advanced cancer (22,45,(47)(48)(49). Inclusion criteria were incurable cancer, aged 18 years or older.…”

Diagnosing Levels of Distress in Specialist Palliative Care

“…We would assert that one of the most complex challenges facing health care professionals working in palliative care is the identification and implementation of best-practice methods in the diagnosis of depression in their patients. Depression is the most studied mental health disorder in palliative care [3]. However, no consensus exists on precisely which of the 106 identified tools designed to diagnosis depression should be implemented [3].…”

“…Depression is the most studied mental health disorder in palliative care [3]. However, no consensus exists on precisely which of the 106 identified tools designed to diagnosis depression should be implemented [3]. Without clearly identified means for best practice it is left to the individual health care professional to sift through the available literature which contains a high concentration of polarising contradictions.…”