Michael Sharpe1, Jane Walker2, Christian Holm Hansen3, Paul Martin4, Stefan Symeonides5, Charlie Gourley5, Lucy Wall5, David Weller6, Gordon Murray6. 1. Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK. Electronic address: michael.sharpe@psych.ox.ac.uk. 2. Psychological Medicine Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK. 3. MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK. 4. Psychological Medicine Research, University of Edinburgh Department of Psychiatry, Edinburgh, UK. 5. University of Edinburgh Cancer Research UK Centre, Western General Hospital, Edinburgh, UK. 6. University of Edinburgh Centre for Population Health Sciences, Teviot Place, Edinburgh, UK.
Abstract
BACKGROUND: Medical conditions are often complicated by major depression, with consequent additional impairment of quality of life. We aimed to compare the effectiveness of an integrated treatment programme for major depression in patients with cancer (depression care for people with cancer) with usual care. METHODS: SMaRT Oncology-2 is a parallel-group, multicentre, randomised controlled effectiveness trial. We enrolled outpatients with major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with cancer intervention or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. Depression care for people with cancer is a manualised, multicomponent collaborative care treatment that is delivered systematically by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. Outcome data were collected up until 48 weeks. The primary outcome was treatment response (≥50% reduction in Symptom Checklist Depression Scale [SCL-20] score, range 0-4) at 24 weeks. Trial statisticians and data collection staff were masked to treatment allocation, but participants could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN40568538. FINDINGS: 500 participants were enrolled between May 12, 2008, and May 13, 2011; 253 were randomly allocated to depression care for people with cancer and 247 to usual care. 143 (62%) of 231 participants in the depression care for people with cancer group and 40 (17%) of 231 in the usual care group responded to treatment: absolute difference 45% (95% CI 37-53), adjusted odds ratio 8·5 (95% CI 5·5-13·4), p<0·0001. Compared with patients in the usual care group, participants allocated to the depression care for people with cancer programme also had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all timepoints (all p<0·05). During the study, 34 cancer-related deaths occurred (19 in the depression care for people with cancer group, 15 in the usual care group), one patient in the depression care for people with cancer group was admitted to a psychiatric ward, and one patient in this group attempted suicide. None of these events were judged to be related to the trial treatments or procedures. INTERPRETATION: Our findings suggest that depression care for people with cancer is an effective treatment for major depression in patients with cancer. It offers a model for the treatment of depression comorbid with other medical conditions. FUNDING: Cancer Research UK and Chief Scientist Office of the Scottish Government.
BACKGROUND: Medical conditions are often complicated by major depression, with consequent additional impairment of quality of life. We aimed to compare the effectiveness of an integrated treatment programme for major depression in patients with cancer (depression care for people with cancer) with usual care. METHODS: SMaRT Oncology-2 is a parallel-group, multicentre, randomised controlled effectiveness trial. We enrolled outpatients with major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with cancer intervention or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. Depression care for people with cancer is a manualised, multicomponent collaborative care treatment that is delivered systematically by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. Outcome data were collected up until 48 weeks. The primary outcome was treatment response (≥50% reduction in Symptom Checklist Depression Scale [SCL-20] score, range 0-4) at 24 weeks. Trial statisticians and data collection staff were masked to treatment allocation, but participants could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN40568538. FINDINGS: 500 participants were enrolled between May 12, 2008, and May 13, 2011; 253 were randomly allocated to depression care for people with cancer and 247 to usual care. 143 (62%) of 231 participants in the depression care for people with cancer group and 40 (17%) of 231 in the usual care group responded to treatment: absolute difference 45% (95% CI 37-53), adjusted odds ratio 8·5 (95% CI 5·5-13·4), p<0·0001. Compared with patients in the usual care group, participants allocated to the depression care for people with cancer programme also had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all timepoints (all p<0·05). During the study, 34 cancer-related deaths occurred (19 in the depression care for people with cancer group, 15 in the usual care group), one patient in the depression care for people with cancer group was admitted to a psychiatric ward, and one patient in this group attempted suicide. None of these events were judged to be related to the trial treatments or procedures. INTERPRETATION: Our findings suggest that depression care for people with cancer is an effective treatment for major depression in patients with cancer. It offers a model for the treatment of depression comorbid with other medical conditions. FUNDING: Cancer Research UK and Chief Scientist Office of the Scottish Government.
Authors: Kelly E Irwin; Beverly Moy; Lauren E Fields; Catherine A Callaway; Elyse R Park; Lori Wirth Journal: J Clin Oncol Date: 2019-04-15 Impact factor: 44.544
Authors: Richard Baird; Ian Banks; David Cameron; John Chester; Helena Earl; Mark Flannagan; Adam Januszewski; Richard Kennedy; Sarah Payne; Emlyn Samuel; Hannah Taylor; Roshan Agarwal; Samreen Ahmed; Caroline Archer; Ruth Board; Judith Carser; Ellen Copson; David Cunningham; Rob Coleman; Adam Dangoor; Graham Dark; Diana Eccles; Chris Gallagher; Adam Glaser; Richard Griffiths; Geoff Hall; Marcia Hall; Danielle Harari; Michael Hawkins; Mark Hill; Peter Johnson; Alison Jones; Tania Kalsi; Eleni Karapanagiotou; Zoe Kemp; Janine Mansi; Ernie Marshall; Alex Mitchell; Maung Moe; Caroline Michie; Richard Neal; Tom Newsom-Davis; Alison Norton; Richard Osborne; Gargi Patel; John Radford; Alistair Ring; Emily Shaw; Rod Skinner; Dan Stark; Sam Turnbull; Galina Velikova; Jeff White; Alison Young; Johnathan Joffe; Peter Selby Journal: Ecancermedicalscience Date: 2016-01-05