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Findings from the Psychological Medicine Research group published in The Lancet journals highlight the high prevalence of untreated depression in patients with cancer and show that a novel treatment programme, 'Depression Care for People with Cancer' (DCPC) can significantly reduce depression and improve patients' lives.

New approach could transform treatment of major depression in patients with cancer
Prof Michael Sharpe

Research led by Prof Michael Sharpe and Dr Jane Walker has been published in three papers in The Lancet Psychiatry, The Lancet and The Lancet Oncology. http://www.thelancet.com/themed/depression-and-cancer

The research has received national and international media attention including an interview with Prof Sharpe on BBC Radio 4's Today programme. http://www.bbc.co.uk/programmes/b04fcs23

The research analysed data from more than 21,000 patients attending cancer clinics in Scotland and found that major depression is substantially more common in patients with cancer than in the general population.  Moreover, nearly three quarters (73%) of depressed cancer patients were not receiving treatment for their depression. 

To address the problem of inadequate treatment, the researchers evaluated the effectiveness of a new treatment programme called 'Depression Care for People with Cancer' (DCPC) in a randomised trial called SMaRT Oncology-2. The trial involved 500 adults with major depression and a cancer with a good prognosis (they had a predicted survival of more than 12 months), and compared DCPC with usual care. 

The DCPC treatment programme is delivered by a team of specially trained cancer nurses and psychiatrists working in collaboration with the patient's cancer team and general practitioner, and is given as part of cancer care. It is a systematic treatment programme that includes both antidepressants and psychological therapy.

At 6 months, 62% of the patients who received DCPC responded to treatment (at least a 50% reduction in the severity of their depression) compared with only 17% of those who received usual care. This benefit was sustained at 12 months.

DCPC also improved anxiety, pain, fatigue, functioning, and overall quality of life. Moreover, the cost of providing DCPC was modest (£613 per patient) making it a cost-effective way to improve cancer patients' quality of life.

To see if patients having a cancer with poor prognosis could also benefit from this approach, the researchers carried out the SMaRT Oncology-3 randomised trial. This tested a version of DCPC that was adapted for patients with lung cancer, a typically poor prognosis cancer. 

The trial, involving 142 patients with lung cancer and major depression, found that those who received the lung cancer version of DCPC had a significantly greater improvement in depression than those who received usual care during 32 weeks of follow-up. The lung cancer-specific version of DCPC also improved anxiety, functioning, and quality of life.

Prof Sharpe and Dr Walker conclude that the combined work highlights huge benefits and shows what can be achieved for patients if we take as much care with the treatment of their depression as we do with the treatment of their cancer.

 The work was funded by Cancer Research UK and the Chief Scientist Office of the Scottish Government.