A clinical trial comparing the efficacy of an integrated treatment program for depression in patients with lung cancer compared with usual care.
A randomized controlled trial of English Walker and colleagues published in The Lancet in 2014 testing the effectiveness of a program combining an antidepressant treatment and psychosocial support on the severity of depression in patients with lung cancer. The results show that this intervention reduced the severity of depressive symptoms that intervention patients compared to patients on standard care.
The Study Rationale
18% of cancer deaths worldwide are linked to lung cancer. Its annual incidence continues to increase, especially among women. Only 13% of patients survive 5 years after diagnosis. Patients with this type of cancer generally have a severe major depressive disorder. This comorbidity has harmful effects on symptoms, autonomy and patient quality of life. For those who have a poor prognosis, the experience of depression often impairs the short time they have left to live. The management of major depression in patients with lung cancer then represents a real challenge. Although effective antidepressant treatments are available for people in the general population diagnosed with depression, it is impossible to translate these benefits on depression in people with lung cancer. Therefore, the authors question the effectiveness of a treatment program combining antidepressant treatment and psychosocial support compared with usual care.
Most patients with lung cancer experience a major depressive disorder that deteriorates further the already poor prognosis of this cancer. Researchers are questioning the benefits that could have the combination of an antidepressant treatment and a non-drug intervention.
Psychosocial intervention by nurses associated with antidepressant treatment is effective you it in patients with lung cancer?
English randomized controlled trial of Walker and his colleagues tested the effectiveness of a program combining psychosocial intervention with antidepressant treatment in elderly patients over 18 years old with lung cancer and with major depressive disorder. The predicted survival of the patients was at least 3 months.
142 patients were randomized to two different groups. 68 patients completed the innovative program for four months. 74 patients followed the usual care. For the latter, physicians and oncologists were warned of depression diagnosis of patients. Patients were encouraged to visit their doctor for an antidepressant. The main measure concerns the severity of depression evaluated every month with the PHQ-9 questionnaire. Follow-up was 8 months.
The Non-Pharmacological Intervention (NPI) assessed
The NPI is a psychosocial support program run by qualified and trained nurses who turned to psychiatrists and general practitioners. The program was integrated in lung cancer care. Nurses had to establish a therapeutic relationship with patients. They provided them with information about depression, its treatment offered their psychological techniques such as problem solving strategies and behavioral activation. They were monitoring the progress of patients. Psychiatrists supervised interventions and treatments so that the objectives are achieved and maintained.
The intervention consisted of up to 10 structured sessions with the nurse for 4 months. This phase began immediately after the diagnosis of major depressive disorder is made. The nurse then monitored the PHQ-9 scores in each month by telephone for another four months. All patient records were examined each week at a meeting attended supervising nurses and psychiatrists.
The results show an average of less severity major depressive disorder for patients who underwent interventional program in relation to the group following the usual care. The intervention has reduced the impact of depressive comorbidity. It has also improved the level of anxiety, autonomy and patient quality of life.
It should be noted however that the intervention had no effect on pain, fatigue, physical functioning and on the patients’ health.
A supportive care intervention that incorporates psychological support antidepressant and reduces the severity of major depression in patients with lung cancer compared to standard care.
What it means for Patients
Major depression can be reduced in patients with a poor prognosis of lung cancer by a program combining psychosocial intervention and antidepressant. This benefit resulted improvement in anxiety and quality of life but not health status, pain and fatigue.
What it means for Healthcare Professionals
Despite a rapid deterioration of the health status of patients with lung cancer with a poor prognosis, the combination of a psychosocial intervention conducted by a nurse and an antidepressant improves a frequent comorbidities these patients major depressive disorder. This program also involves making psychiatrists and physicians is perceived as better by patients than current treatments. It also improved anxiety and quality of life but not health status, pain or fatigue.
What it means for Researchers
This study shows the benefits of a support program combining antidepressant and psychological support on the severity of depression. In a qualitative interview, patients said they would recommend this procedure to their friends. Larger clinical trials are needed to evaluate the efficacy and cost-effectiveness of such programs reduce frequent comorbidity in lung cancer, depression. In addition, further adaptation of the program is necessary to meet the unmet needs of patients.
What it means for Policymakers
A support program combining antidepressant and psychological support to four months reduced the severity of a major comorbidities of lung cancer, depression. Research remains to be done to optimize the supportive care in oncology.
Walker J, Hansen CH, Martin P, Symeonides S, Gourley C, Wall L, Weller D, Murray G, Sharpe M (2014). 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. Lancet, 15, 1168-1176.
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To reference this Blog en Sante © article
Ninot G (2015). Reduce depression in patients with lung cancer. Blog en Sante, A57.
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