Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial

Abstract

BACKGROUND Brief tools are needed to screen for depressive symptoms among oncology outpatients. METHODS Patients starting radiotherapy for first diagnosis of any tumor completed distress screening tools including the Patient Health Questionnaire (PHQ-9; PHQ-2), the National Comprehensive Cancer Network-Distress Thermometer (NCCN-DT), and the Hopkins Symptom Checklist (HSCL-25). Patients exceeding validated cutoff scores and a systematic sample of patients who screened negative completed the Structured Clinical Interview for DSM-IV (SCID) Mood Disorder modules via telephone. RESULTS 463 patients from 35 community-based and 2 academic radiation oncology sites were recruited. Of 455 eligible, 66% were women (n=299) with breast (45%), GI (11%), lung (10%), gynecologic (6%), or other (27%) cancers. Seventy-five (16.5%) exceeded screening cut-offs for depressive symptoms. Of these, 42 patients completed the SCID. An additional 37 who screened negative completed the SCID. Among 79 patients completing a SCID, 8 (10.1%) met criteria for major depression, 2 (2.5%) for Dysthymia, and 6 (7.6%) for Adjustment disorder. The PHQ-2 demonstrated good psychometric properties for screening for mood disorders, using a cut-off score ≥ 3 (ROC area under the curve=0.83) and was comparable to the PHQ-9 (> 9; AUC=0.85). The NCCN-DT did not detect depression (AUC=0.59). CONCLUSION The PHQ-2 demonstrated good psychometric properties to screen for mood disorders, which were equivalent to the PHQ-9 and superior to the NCCN-DT. These findings support using the PHQ-2 to identify patients in need of further assessment for depression, a low prevalence but clinically significant comorbidity. Findings can inform implementation of distress screening accreditation standards.

Implementing and feasibility testing depression screening using the electronic medical record for patients with type 2 diabetes admitted to the hospital

“…One of the providers who responded to the survey contemplated the possibility of “false positive screens” among hospitalized patients due to physical symptoms. However, previous studies (Karamchandani et al, ; Wagner et al, ) supported the feasibility and acceptability of depression screening in hospitalized patients using different screening tools, including the PHQ‐9, the screening tool used in this study (Kroenke et al, ).…”

Responding to the quality imperative to embed mental health care into ambulatory oncology

“…These new standards of care have raised greater awareness of available instruments, their validity and clinical utility, and the implementation processes that are in place. This work by Wagner et al lends support to the utility of a brief clinic‐based questionnaire in identifying patients at risk for depression. Given the multiple challenges faced across the cancer care continuum, we recommend that multidimensional approaches extending beyond the assessment of depression and anxiety and considering physical symptoms and practical concerns be considered as part of systematic psychosocial screening in oncology practice.…”

“…In contrast, other instruments appear to be more precise measures, particularly for identifying depression. In Wagner et al's study of patients enrolled in Radiation Therapy Oncology Group 0841 who were about to undergo radiotherapy, participants completed 4 clinic‐based depression screening questionnaires: Patient Health Questionnaire 9 (PHQ‐9), 2 depression items from the PHQ‐9 (PHQ‐2), Hopkins Symptom Checklist 25, and the single‐item NCCN DT. Approximately 16% of the patients screened positive for depression on any of the 4 instruments.…”

“…There are several important implications of Wagner et al's work . First, oncology patients can be effectively engaged to undergo distress screening in clinic‐based settings with brief screening tools.…”

“…In this issue of Cancer , Wagner et al present the results of a practical, valid approach to screening for depression in outpatient oncology settings. In this study conducted by the Radiation Therapy Oncology Group, the authors evaluated whether a brief and valid 2‐item depression screener effectively identified patients who needed further assessment for depression, and they examined the extent to which this brief instrument was as effective as lengthier assessments in identifying patients who met the criteria for a depressive disorder.…”