Spotting Cancer Depression Easy as 1-2

Cancer patient depression may be accurately identified with two questions

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Being diagnosed with and treated for cancer can be as emotionally troubling as it is physically demanding. But identifying cancer patients who may need to be treated for depression may have gotten a little easier.

A two-question survey has been shown to be accurate in screening cancer patients for major depression.

The study authors hope more radiation therapy centers will use this tool so that depressed patients can be referred for treatment.

"If you’re feeling down, ask for help."

William Small, Jr., MD, FASTRO, chair of the Department of Radiation Oncology of Loyola University Medical Center, presented the tool and the findings relating to the screening method at the American Society for Radiation Oncology’s 55th Annual Meeting.

Researchers wanted to know if the top two questions of the commonly used nine-question Patient Health Questionnaire could offer accurate assessment of major depression.

The two-question survey asked patients to think about how they had been feeling over the previous two weeks:

  • Little interest or pleasure in doing things
  • Feeling down, depressed or hopeless

The three possible responses were scored — “not at all” resulted in zero points; “more than half the days” was one point; and “nearly every day” got two points.

Patients whose responses on both questions added up to more than three points were considered at risk for major depression.

To evaluate the effectiveness of this tool, the researchers worked with 454 cancer patients receiving radiation therapy at 37 centers throughout the US.

Participants were surveyed before beginning or within two weeks of their first radiation treatment. They were surveyed with the nine-question Patient Health Questionnaire, the two-question Patient Health Questionnaire or the single question National Comprehensive Cancer Network Distress Thermometer.

The researchers learned that the two-question tool was just as accurate as the longer nine-question Patient Health Questionnaire, both being 83 percent accurate.

The two-question instrument was more accurate than the Hopkins Symptom Survey, which had 79 percent accuracy, and the National Comprehensive Cancer Network Distress Thermometer, which correctly identified 60 percent of depressed cancer patients.

Of the patients surveyed, 16 percent scored positively for depression. These individuals, along with a sample of other patients, were interviewed at length over the telephone using Structured Clinical Interview for DSM IV Disorders (SCID) Mood Disorders modules.

"Because the survey questions used to accurately identify depression in this study are so direct, it also supports the idea that when people self-report that they are depressed, they are likely to actually meet criteria for that diagnosis and should be taken seriously," Charlotte Howard, PhD, a licensed psychologist and certified group psychotherapist in Austin, TX and author of the self-help book for couples, Awaken to Love, told dailyRx News.

The researchers also looked at the availability of depression assessment and mental health services available at the radiation therapy facilities involved in the study, and they discovered the following:

  • 78 percent of the facilities routinely screened for depression.
  • 51 percent screened at the first visit.
  • 68 percent of sites offered mental health services.
  • 67 percent of the sites had social workers who could offer mental health services.
  • 17 percent of the facilities had psychologists.
  • 22 percent had psychiatrists available.

“We think the results of this large, nationwide trial will have a major impact on how cancer patients are screened for depression,” Dr. Small said in a prepared statement.

This study was supported by the Radiation Oncology Therapy Group Community Clinical Oncology Program, with funding from the National Institutes of Health.

All research is considered preliminary before it is published in a peer-reviewed journal.

No conflicts of interest were reported.

Review Date: 
September 22, 2013
Last Updated:
September 23, 2013