Gaps in the Management of Depression Symptoms Following Cancer Diagnosis: A Population-Based Analysis of Prospective Patient-Reported Outcomes

Abstract

Background One of the most common psychological morbidities of cancer is depression. Routine depression symptoms screening (DSS) is recommended, but its ability to lead to psychosocial interventions in clinical practice is limited. We examined the use of and factors associated with psychosocial interventions for positive DSS following cancer diagnosis. Materials and Methods We conducted a population‐based cohort study of patients with diagnoses from 2010 to 2017 who reported ≥1 patient‐reported Edmonton Symptom Assessment System (ESAS) score. Positive DSS was defined as ESAS ≥2 out of 10 for the depression item within 6 months of diagnosis. Outcomes were psychosocial interventions around the time of positive DSS: palliative care assessment, psychiatry/psychology assessment, social work referral, and antidepressant therapy (in patients ≥65 years of age with universal drug coverage). We examined reduction in depression symptom score (≥1 point) following intervention. Modified Poisson regression examined factors associated with interventions. Results Of 142,270 patients, 65,424 (46.0%) reported positive DSS at a median of 66 days (interquartile range: 34–105) after diagnosis. Of those with depression symptoms, 17.1% received palliative assessment, 1.7% psychiatry/psychology assessment, 8.4% social work referral, and 4.3% antidepressant therapy. Depression symptom score decreased in 67.2% who received palliative assessment, 63.7% with psychiatry/psychology assessment, 67.3% with social work referral, and 71.4% with antidepressant therapy. On multivariable analysis, patients with older age, rural residence, lowest income quintile, and genitourinary or oropharyngeal cancer were more likely to not receive intervention other than palliative care. Conclusion The proportion of patients reporting positive DSS after cancer diagnosis receiving psychosocial intervention is low. We identified patients vulnerable to not receiving interventions, who may benefit from additional support. These data represent a call to action to modify practice and optimize the usefulness of systematic symptom screening. Implications for Practice Patient‐reported depression symptoms screening should be followed by targeted interventions to improve symptoms and patient‐centered management.

Mental disorders, length of hospitalization, and psychopharmacy–New approaches to identify barriers to psychological support for patients with cancer

“…distress screening, latent class analysis, length of stay, psychiatric disorders, psycho-oncology, psychopharmacology 1 | BACKGROUND Psychological distress 1 has been reported in 30%-50% of cancer patients 2-7 and is persistent even in cancer survivors in 20%-40% of cases. 2,8 Such symptoms often remain unnoticed in primarily somatic treatment settings, 3,[9][10][11][12] even when pronounced psychopathology is present. 9,10,12 As a consequence, consensus-based treatment guidelines have recommended screening for distress in cancer patients as part of routine treatment.…”

“…2,8 Such symptoms often remain unnoticed in primarily somatic treatment settings, 3,[9][10][11][12] even when pronounced psychopathology is present. 9,10,12 As a consequence, consensus-based treatment guidelines have recommended screening for distress in cancer patients as part of routine treatment. 13,14 The process of screening is recommended to facilitate access to psychosocial support to those in need.…”

Symptom burden in transplant-ineligible patients with newly diagnosed multiple myeloma: a population-based cohort study

“…From the oncology team's perspective, understanding the considerable burden of symptoms both at diagnosis and over time may be an essential first step in incorporating multidisciplinary teams, with a specific focus on managing psychosocial symptoms, which are known to be often unaddressed by oncology teams. 6 Several patient characteristics were identified in our study as being associated with an increased odds of experiencing high symptom burden. Although increasing age was associated with a slight decrease in symptom burden, given the minimal change in odds ratio, the clinical impact of this is unknown.…”

“…From the oncology team’s perspective, understanding the considerable burden of symptoms both at diagnosis and over time may be an essential first step in incorporating multidisciplinary teams, with a specific focus on managing psychosocial symptoms, which are known to be often unaddressed by oncology teams. 6 …”

Patient-reported outcome measures are associated with health care utilization in patients with transplant ineligible multiple myeloma: a population-based study

“…While the exact cause of this cannot be elucidated from our study, it is possible that depression may lead to social isolation and ineffective utilization of health care services [ 9 ]. As interventions for depressive symptoms are known to be poorly addressed [ 10 ], the finding from our study suggests the need to identify and proactively support interventions for patients reporting depressive symptoms.…”