RTOG 0841: Two Item Questionnaire Effectively Screens for Depression in Cancer Patients Receiving Radiotherapy
Reporter: Jacob E. Shabason
Department of Radiation Oncology of the University of Pennsylvania
Last Modified: September 24, 2013
The following reports were chosen because of their relevance to patients during and after cancer treatment. These presentations were made at the 55th annual meeting of the American Society for Radiation Oncology (ASTRO) in Atlanta Georgia.
Author: William Small
Affiliation: Loyola University Health System, Chicago, Illinois.
Depression is a very common problem in patients with cancer, where approximately 25% of patients will develop some degree of depression in their disease course. Depression in these patients often time leads to decreased quality of life, increased morbidity and mortality and poor medical compliance.
However, depression among patients receiving radiotherapy has not been thoroughly studied. As such the authors sought to test the feasibility of a screening survey to help detect patients with major depressive symptoms and assess the availability of psychosocial care. Specifically, either prior to or within two week of starting radiation patients were given 9 item Patient Health Questionnaire with an imbedded 2 item section (PHQ-9 and PHQ-2 respectively), as well as a single item National Comprehensive Cancer Network-Distress Thermometer (NCCN-DT). Then patients who screen positive by these surveys and a sampling of patients who screened negative had a more thorough evaluation through a Structured Clinical Interview for DSM IV Disorders (SCID) Mood Disorder modules by telephone.
This study rapidly accrued 463 patients from 27 different radiation oncology centers. All eligible patients in the study completed the screening questionnaires. Overall, 75 (16%) of the patients screened positive for depressive symptoms. The PHQ-9 and PHQ-2 questioners were superior to the NCCN-DT in detecting depression. In addition, the authors found that only 68% of the sites in the study had associated mental health services. Furthermore, 67% of the facilities with mental health services only had social workers for support. Far less had psychologists (17%) or psychiatrists (22%) available for support.
This study demonstrates the feasibility of performing simple depression screening in radiation oncology clinics and identifies the PHQ-2 as the most appropriate questionnaire. Given that 16% of patients screened positive for depression, it is certainly worthwhile for radiation oncology centers to adapt this survey to help identify patients with depression and then provide them with timely and appropriate mental health services. Moreover, it is vital for radiation oncology centers to become equipped to handle depression by providing improved mental health support services or at least develop easy and rapid referrals for psychosocial services.