Use of a Depression Screening Tool and a Fluoxetine-Based Algorithm to Improve the Recognition and Treatment of Depression in Cancer Patients

Passik, Steven D.; Kirsh, Kenneth L.; Theobald, Dale; Donaghy, Kathleen; Holtsclaw, Elizabeth; Edgerton, Sarah; Dugan, William

doi:10.1016/s0885-3924(02)00493-1

Cited by 44 publications

(24 citation statements)

References 32 publications

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“…Although nearly all the oncologists reported intervening once psychosocial distress was identified, many of their patients may not receive mental health treatment because of lack of recognition. For about half of oncology patients with psychiatric disorders, such as major depression, the disorders go unrecognized by their oncologists (7). The majority of oncologists, and even those in NCCN institutions, do not routinely screen with methods that are accurate for detection of psychosocial distress (4,8).…”

Section: Discussionmentioning

confidence: 99%

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Management of Psychosocial Distress by Oncologists

Muriel¹,

Hwang²,

Kornblith³

et al. 2009

Psychiatric Services

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Objective-Little is known about the nature of psychosocial care delivered by oncologists. The goal of this study was to survey oncologists about their management of psychosocial distress, referencing the National Comprehensive Cancer Network guidelines.Methods-A random sample of 1,000 oncologists were sent an e-mail requesting their participation in an online survey; nonrespondents were sent the survey through postal mail. Regression analyses were conducted to identify independent predictors of care.Results-Forty-six percent (448 of 965) of oncologists responded. Practice locations included: community (63%), cancer center (25%), and hospital (7%). Respondents estimated that over onethird of their patients (mean± SD=38%±22%) experience psychosocial distress warranting intervention, although only 225 of 447 (50%) indicated having mental health services affiliated with their practice. Nearly half (212 of 447, 47%) reported only initiating a referral for psychosocial services, and 214 of 447 (48%) reported both making a referral and starting psychiatric medications, mainly selective serotonin reuptake inhibitors and benzodiazepines.Conclusions-Most oncologists delivered some level of psychosocial care, although only half had affiliated mental health services.Although the majority of Americans receive mental health care from medical providers who are not mental health clinicians, little is known about the extent to which sub-specialists provide such care (1). Most of the prior research on the delivery of mental health services in medical settings has taken place in primary care. With the recent publication of the Institute

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Section: Discussionmentioning

confidence: 99%

“…However, patients with severe medical co-morbidities may be less likely to follow through with referrals in the community. Without available mental health clinicians, developing screening tools and treatment protocols that oncologists themselves could implement may be useful (7).…”

Section: Discussionmentioning

confidence: 99%

Management of Psychosocial Distress by Oncologists

Muriel¹,

Hwang²,

Kornblith³

et al. 2009

Psychiatric Services

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“…Several reports have suggested the usefulness of integrated screening programs in clinical oncology settings. Those programs provide pharmacotherapy by oncologists using antidepressant algorithms 31,32 or psychologic intervention delivered by cancer nurses under the supervision of a consultant psychiatrist 33 to patients who screened positive. Simple intervention, meaning feeding back the results of the screening alone, however, does not seem to be useful.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the nurse‐assisted screening and psychiatric referral program

Shimizu

Akechi

Okamura

et al. 2005

Cancer

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BACKGROUNDMajor depression and adjustment disorders are common psychiatric disorders in patients with cancer, but they are often overlooked in clinical oncology settings. The nurse‐assisted screening and psychiatric referral program (NASPRP) has been introduced in clinical practice to facilitate psychiatric treatment for major depression and adjustment disorders. This study assessed the usefulness of the NASPRP and compared it with usual practice.METHODSThe program consists of two stages. In the first stage, consecutive patients newly admitted to the Oncology/Hematology Unit are administered the Distress and Impact Thermometer (DIT) by nurses as a brief screening tool for major depression and adjustment disorders. In the second stage, the nurses recommend psychiatric referral to patients with scores above the cutoff point. Patients' records were reviewed for a 3‐month period before the start of the program and during the 3‐month period after the start of the program. These records were then compared.RESULTSOf 157 patients newly admitted during the program period, 86.0% (135/157) completed the DIT and results were positive in 49.6% (67/135), but only 28.2% (19/67) accepted psychiatric referral. Ultimately, 11.5% (18/157) of patients newly admitted were diagnosed with major depression or adjustment disorders and treated by psychiatric service, a significantly higher proportion than during the preceding 3‐month period, before the program was begun (2.5%; P = 0.001).CONCLUSIONThe NASPRP enabled identification of major depression and adjustment disorders in patients with cancer and introduced them to psychiatric treatment. Nevertheless, there is room for improvement in the program. Cancer 2005. © 2005 American Cancer Society.

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“…On the other hand, physicians and nurses often fail to identify distressed patients (Newell et al, 1998;Fallowfield et al, 2001;Söllner et al, 2001;Keller et al, 2004), resulting in under-treatment in 40 -90% of the cases (Flatten et al, 2003;Singer et al, 2005). It is, nevertheless, possible to improve the detection rates and treatment with intensive training (Passik et al, 2002;Adkins et al, 2005).…”

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confidence: 99%

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care

et al. 2009

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The aim of this study was to determine optimal cutoff scores for the Hospital Anxiety and Depression Scale (HADS) when used in evaluating cancer patients in acute care. A total of 689 cancer patients were assessed during their first days of in-patient treatment, using the structured clinical interview for DSM and the HADS. Statistical analysis was performed using ROC curves. A total of 222 patients (32%) had a mental disorder. The area under the curve was the best in the total scale of the HADS, namely 0.73. With a score of X13, it is possible to detect 76% of the cases with a specificity of .60, whereas 95% of the cases can be detected with a score of X6 (specificity 0.21). With scores of X16 and X22, recommended by the test authors for primary care, only 59 and 30% of the comorbid cancer patients are indicated. Lower HADS cutoff scores when preferable when evaluating cancer patients than are recommended for use in primary care. When using HADS in clinical practice and epidemiological studies, it is important to decide whether, for the task at hand, high detection rates of affected patients or low misclassification rates are more important.

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Use of a Depression Screening Tool and a Fluoxetine-Based Algorithm to Improve the Recognition and Treatment of Depression in Cancer Patients

Cited by 44 publications

References 32 publications

Management of Psychosocial Distress by Oncologists

Management of Psychosocial Distress by Oncologists

Usefulness of the nurse‐assisted screening and psychiatric referral program

Hospital anxiety and depression scale cutoff scores for cancer patients in acute care

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