In the Journals

Depression treatment does not improve survival in patients with depression, cancer

Michael Sharpe
 

Clinical evidence showed that Depression Care for People with Cancer, a depression treatment program, improved depression and quality of life in patients with depression and cancer, but not survival, according to findings published in The Lancet Psychiatry.

“Major depression comorbid with cancer is a suitable specific psychiatric diagnosis to target. This condition affects about 10% of patients with cancer and has been associated with worse survival in multiple studies,” author Michael Sharpe, MD, FRCPsych, of the department of psychiatry, University of Oxford, England, and colleagues wrote. “Despite the association with worse survival, we are not aware of any trials that have aimed to find out if giving treatment for depression (pharmacological, psychological, or both) to patients with cancer and depression improves their survival.”

In two previous studies (the SMaRT Oncology-2 and -3), Sharpe and colleagues found that a systematically delivered depression treatment program that offered both pharmacological and psychological care reduced comorbid major depression among patients with cancer. In the current study, they examined its effect on survival.

The researchers recruited participants to these trials from three cancer centers and their clinics in Scotland. In SMaRT Oncology-2, they randomly allocated 500 outpatients (1:1) with good prognosis cancers and major depression to receive treatment through the program or usual care, stratifying by trial center, age, primary cancer and sex. In SMaRT Oncology-3, the same approach was used for 142 patients with lung cancer and major depression. Using long-term all-cause mortality data from these patients, the investigators examined survival as a trial outcome.

Patients were followed for a median of 5 years in the SMaRT Oncology-2 trial, and during that time, 135 (27%) of 500 patients died. In SMaRT Oncology-3, patients were followed for 1 year, during which 114 (80%) of 142 participants died. In SMaRT Oncology-2, 69% of participants assigned to usual care and 72% of those assigned to the depression treatment program group survived to 6 years. In SMaRT Oncology-3, 15% of the usual care group and 23% of the treatment program group survived to 6 years.

Although the treatment program improved depression in patients with depression and cancer, it showed no significant effect on survival during the follow-up period for participants in the SMaRT Oncology-2 trial (HR = 1.02; 95% CI, 0.72–1.42; P = .93) or those in the SMaRT Oncology-3 trial (HR = 0.82; 95% CI, 0.56–1.18; P = .28). The pooled HR for survival was 0.92 (95% CI, 0.72–1.18; P = .51).

“This study followed up the participants in these trials to find out whether treating depression also increases their survival. We found no evidence that it does,” Sharpe told Healio Psychiatry. “We conclude that whilst treating depression may not increase the length of life of people with cancer, its marked effect on their quality of that life still makes it a priority for cancer services.”

In a related comment, Alex J. Mitchell, MD, MRCPsych, from University of Leicester, England, wrote that survival disadvantages in patients with mental illness can largely be attributed to the gap in screening for cancer in this group, late diagnosis and lower quality cancer care.

“For these reasons, differences in cancer survival are unlikely to be corrected in randomized trials in patients with depression, but that should not detract from the message that depression remains a key target for prompt recognition and appropriate treatment, including the urgent necessity to reduce any inequalities in cancer care related to patients’ pre-existing or current mental ill health,” Mitchell wrote. – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures. Mitchell reports no relevant financial disclosures.

Michael Sharpe
 

Clinical evidence showed that Depression Care for People with Cancer, a depression treatment program, improved depression and quality of life in patients with depression and cancer, but not survival, according to findings published in The Lancet Psychiatry.

“Major depression comorbid with cancer is a suitable specific psychiatric diagnosis to target. This condition affects about 10% of patients with cancer and has been associated with worse survival in multiple studies,” author Michael Sharpe, MD, FRCPsych, of the department of psychiatry, University of Oxford, England, and colleagues wrote. “Despite the association with worse survival, we are not aware of any trials that have aimed to find out if giving treatment for depression (pharmacological, psychological, or both) to patients with cancer and depression improves their survival.”

In two previous studies (the SMaRT Oncology-2 and -3), Sharpe and colleagues found that a systematically delivered depression treatment program that offered both pharmacological and psychological care reduced comorbid major depression among patients with cancer. In the current study, they examined its effect on survival.

The researchers recruited participants to these trials from three cancer centers and their clinics in Scotland. In SMaRT Oncology-2, they randomly allocated 500 outpatients (1:1) with good prognosis cancers and major depression to receive treatment through the program or usual care, stratifying by trial center, age, primary cancer and sex. In SMaRT Oncology-3, the same approach was used for 142 patients with lung cancer and major depression. Using long-term all-cause mortality data from these patients, the investigators examined survival as a trial outcome.

Patients were followed for a median of 5 years in the SMaRT Oncology-2 trial, and during that time, 135 (27%) of 500 patients died. In SMaRT Oncology-3, patients were followed for 1 year, during which 114 (80%) of 142 participants died. In SMaRT Oncology-2, 69% of participants assigned to usual care and 72% of those assigned to the depression treatment program group survived to 6 years. In SMaRT Oncology-3, 15% of the usual care group and 23% of the treatment program group survived to 6 years.

Although the treatment program improved depression in patients with depression and cancer, it showed no significant effect on survival during the follow-up period for participants in the SMaRT Oncology-2 trial (HR = 1.02; 95% CI, 0.72–1.42; P = .93) or those in the SMaRT Oncology-3 trial (HR = 0.82; 95% CI, 0.56–1.18; P = .28). The pooled HR for survival was 0.92 (95% CI, 0.72–1.18; P = .51).

“This study followed up the participants in these trials to find out whether treating depression also increases their survival. We found no evidence that it does,” Sharpe told Healio Psychiatry. “We conclude that whilst treating depression may not increase the length of life of people with cancer, its marked effect on their quality of that life still makes it a priority for cancer services.”

In a related comment, Alex J. Mitchell, MD, MRCPsych, from University of Leicester, England, wrote that survival disadvantages in patients with mental illness can largely be attributed to the gap in screening for cancer in this group, late diagnosis and lower quality cancer care.

“For these reasons, differences in cancer survival are unlikely to be corrected in randomized trials in patients with depression, but that should not detract from the message that depression remains a key target for prompt recognition and appropriate treatment, including the urgent necessity to reduce any inequalities in cancer care related to patients’ pre-existing or current mental ill health,” Mitchell wrote. – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures. Mitchell reports no relevant financial disclosures.