Depression screening for cancer patients too often falls between the cracks

Dec 10 2007

Depression is known to be associated with cancer yet too many cancer patients are not screened for this mental disorder, according to researchers from the Indiana University School of Medicine, the Regenstrief Institute and the Roudebush VA Medical Center.

In a study published in the November-December issue of General Hospital Psychiatry, Caroline Carney Doebbeling, M.D., M.Sc. and Laura Jones, Ph.D., looked at data from the Roudebush VA Medical Center, where 95 percent of veterans in primary care are screened for depression.

They report that depression screening in cancer patients was not done nearly as frequently with, for example, only slightly over half of veterans with lung cancer receiving screening. “In places without integrated care and mandated primary care depression screening like the VA, we speculate that screening rates are even worse,” said Dr. Carney Doebbeling, associate professor of medicine and of psychiatry at the Indiana University School of Medicine and a Regenstrief Institute research scientist.

Lung cancer has one of the highest associations with depression of any cancer, according to Dr. Doebbeling, who is an internist and a psychiatrist. Many lung cancer patients have a history of smoking which has a strong association with depression and anxiety disorders.

“In any clinical setting, the cancer care provider needs to care for the patient's mental as well as physical needs through the course of treatment. Once cancer develops, an individual who is depressed may be less likely to be adherent to their cancer therapy regimen as has been shown in other conditions like heart disease and diabetes. This issue has not yet been sufficiently studied in cancer yet,” says Dr. Carney Doebbeling. “What is clear is that cancer patients treated for depression report a better quality of life during the course of treatment. This comes back around to the need to screen and recognize depression early on.”

Why do doctors fail to screen cancer patients for depression" “When doctors think their patients have a higher risk of mortality, depression screening is not as big a focus. Clinicians need to be made aware that depression screening is important even in end-stage cancer,” said Dr. Jones, who is with the Roudebush VA Medical Center's Center of Excellence on Implementing Evidence-Based Practice and is a health services researcher.

Dr. Carney Doebbeling adds, “Cancer survivorship is an especially difficult experience if you are depressed. If we as clinicians don't have long-term awareness of patients' depression how can we expect them to do well through the course of their treatment and beyond, no matter how long they have post treatment"