Depression is two to three times more common in patients with cancer than the general population, recent studies suggest. Major depression, then, may be viewed as a relatively common complication of cancer, and its effects might even shorten survival. Three articles appearing in Lancet publications contain new research concerning depression in cancer patients.

Strikingly, the various studies reveal that around three-quarters of cancer patients with major depression do not receive treatment. However, a new integrated treatment program was found to effectively improve quality of life and reduce depression. “Major depression is common in patients attending cancer clinics and most goes untreated,” wrote the authors of the paper appearing in The Lancet Psychiatry. “A pressing need exists to improve the management of major depression for patients attending specialist cancer services.”

Prevalance of Depression: The Lancet Psychiatry

Seeking reliable figures as to the prevalence of depression in cancer patients, a team of UK-based researchers analyzed data from more than 21,000 patients with breast, lung, colorectal, genitourinary, or gynaecological cancer at cancer clinics in Scotland between 2008 and 2011. While corroborating claims that depression is substantially more common in cancer patients than in the general population, they also discovered nearly three quarters (73 percent) of depressed cancer patients were not receiving treatment. Incidence of depression was most common in patients with lung cancer (13 percent) and lowest in those with genitourinary cancer (6 percent). Nearly 11 percent of patients with gynecological cancer experienced depression, nine percent among breast cancer patients, and seven percent among colorectal cancer patients. For lung cancer and colorectal cancer, female patients were more likely to be diagnosed with major depression, while generally, younger patients and those with worse social deprivation scores were likely candidates.

Effectiveness of Depression Care: The Lancet

To alleviate depression among cancer patients, researchers whose work appears in The Lancet developed a complex collaborative care intervention. This intervention involves both antidepressant medication and psychological treatment and includes assistance from a nursing case manager, a primary care physician, a psychiatrist, and the patient's oncologist. The SMaRT Oncology-2 study of depression care for people with cancer included 500 patients, all with an expected survival of at least one year and a diagnosis of major depression. The patients, 90 percent women and drawn from three cancer centers in Scotland, were randomly assigned to the depression care intervention or to usual care. Of those in the depression care group, 62 percent had a response at 24 weeks, compared with only 17 percent of those in the usual care group. Significantly, the benefit to patients was sustained at 12 months. Patients receiving the depression care intervention also reported improved anxiety, pain, fatigue, functioning, and overall quality of life.

Effectiveness of Depression Care 2: The Lancet Oncology

While depression care showed impressive results among cancer patients with a relatively good prognosis, how would it work among those patients suffering from poor prognosis cancers, such as lung cancer? To test a version of depression care adapted for lung cancer patients, researchers devised the SMaRT Oncology-3 trial, the results of which are published in The Lancet Oncology. The study involved 142 patients with lung cancer and major depression; 68 patients were randomly assigned to depression care group and 74 to the usual care group. By 32 weeks, 30 percent of the total 142 patients had died. The researchers found average depression severity was significantly lower in patients within the depression care group compared to those in the usual care group. The special depression treatment also improved anxiety, functioning, and quality of life.

"Patients with lung cancer often have a poor prognosis. If they also have major depression that can blight the time they have left to live,” noted Dr. Jane Walker from the University of Oxford and lead author of this study. “This trial shows that we can effectively treat depression in patients with poor prognosis … and really improve patients' lives."

Sources: Walker J, Hansen CH, Martin P, et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. The Lancet Psychiatry. 2014.

Walker J, Hansen CH, Martin P, et al. Integrated collaborative care for comorbid major depression in cancer patients (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial. The Lancet. 2014.

Walker J, Hansen CH, Martin P, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer. The Lancet Oncology. 2014.