In a related trial (SMaRT Oncology-3), the investigators found that even patients with a poor prognosis respond well to DCPC. Patients in SMaRT Oncology-3 were adults with major depression attending cancer clinics in Scotland between January 2009 and September 2011. All had a diagnosis of primary lung cancer, and a predicted survival of at least 3 months.
Mean depression severity – a summary measure of each participant’s depression severity scores averaged over the course of the study (up to 32 weeks) was significantly lower in 68 patients with lung cancer who were assigned to receive DCPC than in 74 patients assigned to receive usual care (mean Symptom Checklist Depression Scale scores of 1.24 vs. 1.61; standardized mean difference, –0.62), Dr. Walker reported on behalf of the SMaRT Oncology-3 team.
In addition, significantly more patients receiving DCPC achieved at least a 50% reduction in depression severity scale scores (51% vs. 15%).
"We also recorded significant differences between the treatment groups in self-rated depression improvement, anxiety, quality of life, role functioning, and perceived quality of care, all in favor of the depression care for the people with lung cancer group," they said.
"Our findings suggest that, despite the rapid deterioration of this patient group, successful clinical trials in patients with poor-prognosis cancer and comorbid major depression are possible, through adaptation of both trial design and treatment delivery. Our results also suggest that it is possible to effectively treat major depression in this patient group. ... Large trials are now needed to estimate the effectiveness and cost-effectiveness of depression care for people with lung cancer in this population, and further adaptation of the treatment is needed to address the unmet needs of patients with major depression and a shorter life expectancy," they concluded.
The authors reported having no conflicts of interest. The Lancet Psychiatry and Lancet studies were jointly sponsored by the University of Edinburgh and NHS Lothian, and were funded by Cancer Research UK (CRUK), with additional funding from the Chief Scientist Office (CSO) of the Scottish Government and NHS Research Scotland. The Lancet Psychiatry article was also funded by CRUK and the CSO of the Scottish Government. Dr. Walker is supported by Sir Michael Sobell House Hospice, Oxford; and the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford at the Oxford Health NHS Foundation Trust.