Depression in older cancer patients more effectively treated

6 November 2009

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Depression in older cancer patients is very common, and has debilitating effects on their quality of life both during and after treatment. University of Washington researchers are showing that there are ways to better this situation.

"Little is known about the optimal approach to treating depression in this population, and older cancer patients are less likely to be treated for their depression than are younger cancer patients," said Dr Jesse Fann, UW associate professor of psychiatry and behavioural sciences. Fann is the director of psychiatric services at the Seattle Cancer Care Alliance, and an investigator in the Clinical Research Division at the Fred Hutchinson Cancer Research Center in Seattle.

Fann and his colleagues evaluated the effectiveness in older, depressed cancer patients of an intervention called Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), in comparison to a similar set of patients receiving usual care. All participants had either major depression or a type of chronic depression called dysthymia, or a combination of both.

IMPACT participants worked with a depression care manager in their primary-care clinic for up to a year. Under the supervision of the patient's primary-care provider and a psychiatrist, the care manager offered the patient support in taking anti-depressants if prescribed by the primary-care provider, education about depression, care coordination and structured counselling sessions that helped the patient engage in pleasant activities and that taught problem-solving skills.

The intervention was tested in 18 primary-care clinics in 5 states. The clinics served a variety of different socio-economic, geographic, and ethnic populations.

At the end of six months, 55 percent of the patients in the IMPACT group and 34 percent of the usual care participants showed a 50 percent or greater reduction in their depression symptoms. The IMPACT participants also had higher remission rates from depression, more depression-free days, less fatigue, a better quality of life, less functional impairment and fewer thoughts of death. Many of these benefits persisted during the one-year follow up period after the intervention was completed.

"Among the functional impairments older cancer patients can experience with depression are fatigue and thinking problems, such as forgetfulness, feeling mentally slowed down, and having difficulty concentrating or solving problems. Decisions that used to be straightforward or easy for them have become challenging," Fann explained.

Based on their findings, the researchers concluded that the IMPACT collaborative care program is feasible and more effective than standard care in managing depression among older cancer patients in primary-care, and is widely applicable.

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