Depression in cancer patients
Professor Mari Lloyd-Williams – University of Liverpool, UK
I was talking about the study that we recently carried out at the Academic Palliative and Supportive Care Group at the University of Liverpool which was a study of over 629 patients and we followed them up longitudinally over six months to look at how they were coping with their cancer, well advanced cancer, but in particular we were looking at depression because we’re aware that’s a very important symptom for many people.
Actually we recruited patients from 25 hospice day units; we screened them using something called the Edinburgh Depression Scale, which has been validated in palliative care, a tool called the PHQ-9 and we also looked at whether they were having anti-depressant medication, how they felt physically and we asked them to complete some measurement tools looking at physical symptoms. We also used a tool to look how they felt in terms of their spiritual belief as well. Then we followed them up at two, four and six months during the time to have a look and see how things changed in that time.
How did these tools work?
The tools are very simple to fill in; people were able to tick how they felt. So there would be question, for example, ‘Over the last seven days I have felt sad,’ and then you would tick if you’d felt sad every day, most days etc. So they were tools that were specifically chosen because they are valid so we know that they work but also that they’re easy for people who are not so well to complete.
We found that actually depression was an important symptom for a third of patients, so a third of 629 patients, quite a lot of patients. And actually we found that it was a symptom that was very troublesome for many, many patients. It did not significantly get better over the six months of the study which was something that we thought it might have done because these patients were within a palliative care setting, they were in a hospice setting. We found also that anti-depressants didn’t seem to work very well in this patient group which was surprising to us, therefore we’re trying to find out why that may be the case. We also found out that patients who were depressed did not survive as long as patients who were not depressed and that was controlling. So we took into account all other factors in terms of how ill they were etc., so depression was actually an independent risk for people dying sooner.
Why do you think that is?
I think there are lots of reasons, possibly it is because depression makes you feel very, very… you lose interest in everything, you lose a lot of enthusiasm and we all know that actually people with cancer often say that they have a tremendous determination to actually overcome it. So I think if you’re depressed you lose the ability to have those positive thoughts, really. I think it is very, very difficult for people who are depressed if they’ve got any advanced diseases, which is why we need to treat it and pick it up sooner.
We are advocating screening, we’re advocating that all patients with advanced cancer, whether at home, in a hospice or in a hospital should be screened but not only should they be screened but people need to take note of what they fill in. It’s all very easy to give somebody a questionnaire and ask them to fill it in but we really need to look at what they’re saying and actually take that a bit further and look at best ways of managing these people with drugs or looking at other interventions as well. Drugs can work but, as I say, they didn’t really have much effect in our study which we want to uncover. But a lot of patients with cancer, there’s a lot of evidence that people find benefit from things called wellbeing interventions, which are perhaps simple interventions like painting or alternative therapies, that actually they can make a difference. We have no clinical trials for that but anecdotally and from literature we know that that does make a difference. Perhaps what we need to look at is a model of care that includes physical treatment, so tablets, but also looking at these other interventions as well and not only looking at the patient but also their family too.
What plans do you have for the anti-depressants?
We are currently putting a trial together to actually do a proper study. This wasn’t a trial, this was just looking to see what was happening. We were just almost like people sitting in a room observing so this wasn’t a trial but we really need to look at a proper trial which actually compares if people are actually having certain treatments and compares them against another group and that is really important for the future.
