Skip to main content

Advertisement

SpringerLink
Log in

Association between supportive care interventions and patient self-reported depression among advanced cancer outpatients

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Advanced cancer patients often experience moderate to severe physical and emotional distress. One of the main components of emotional distress is depression. The objective of this study was to examine the association between supportive care interventions and patient self-reported depression (PSRD) among advanced cancer outpatients.

Methods

We included consecutive patients seen in the outpatient Supportive Care Center between February 2008 and February 2010 with at least one follow-up visit. We used the Edmonton Symptom Assessment Scale (ESAS) to assess their symptom intensity. Clinical improvement of PSRD was defined as an improvement of at least 30 % between the initial visit and the first follow-up. We used logistic regression models to assess possible predictors of improvement in PSRD.

Results

We included 444 patients with a median age of 59 years (Q1–Q3; 51–65). The most common type of cancer was gastrointestinal (98, 22 %). Out of the 444 patients, 160 (36 %) reported moderate/severe depression at baseline (ESAS item score ≥ 4/10). Higher baseline depression intensity was significantly associated to anxiety (r = 0.568, p = 0.046), total symptom distress score (TSDS; r = 0.550, p < 0.001) and personal history of depression (r = 0.242, p = 0.001). Of the 160 patients, 90 (56 %) with moderate/severe PSRD at baseline showed a significant improvement at the follow-up visit (p = 0.038). Improvement in anxiety, sedation, and feeling of well-being were associated with higher depression improvement (OR 7.93, CI 3.74–16.80 and OR 2.44, CI 1.09–5.46, respectively).

Conclusions

More than 50 % patients with moderate/severe PSRD significantly improved after one single supportive/palliative care consultation. Improvements of anxiety and sedation were independently associated with PSRD improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Walsh D, Rybicki L (2006) Symptom clustering in advanced cancer. Support Care Cancer 14(8):831–836

    Article  PubMed  Google Scholar 

  2. Yennurajalingam S, Urbauer DL, Casper KLB, Reyes-Gibby CC, Chacko R, Poulter V, Bruera E (2011) Impact of a palliative care consultation team on cancer-related symptoms in advanced cancer patients referred to an outpatient supportive care clinic. J Pain Symptom Manag 41(1):49–56

    Article  Google Scholar 

  3. Lloyd-Williams M, Dennis M, Taylor F (2004) A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 18(6):558–563

    Article  PubMed  Google Scholar 

  4. Massie MJ, Gagnon P, Holland JC (1994) Depression and suicide in patients with cancer. J Pain Symptom Manag 9(5):325–340

    Article  CAS  Google Scholar 

  5. Massie MJ, Holland JC (1990) Depression and the cancer patient. J Clin Psychiatry 51(Suppl):12–17, discussion 18–19

    PubMed  Google Scholar 

  6. DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Int Med 160(14):2101–2107

    Article  CAS  Google Scholar 

  7. Rosenstein DL (2011) Depression and end-of-life care for patients with cancer. Dialogues Clin Neurosci 13(1):101–108

    PubMed Central  PubMed  Google Scholar 

  8. Satin JR, Linden W, Phillips MJ (2009) Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer 115(22):5349–5361

    Article  PubMed  Google Scholar 

  9. Lloyd-Williams M, Shiels C, Taylor F, Dennis M (2009) Depression—an independent predictor of early death in patients with advanced cancer. J Affect Disord 113(1–2):127–132

    Article  PubMed  Google Scholar 

  10. Pirl WF, Greer JA, Traeger L, Jackson V, Lennes IT, Gallagher ER, Perez-Cruz P, Heist RS, Temel JS (2012) Depression and survival in metastatic non-small-cell lung cancer: effects of early palliative care. J Clin Oncol 30(12):1310–1315

    Article  PubMed Central  PubMed  Google Scholar 

  11. MumFord E, Schlesinger HJ, Glass GV, Patrick C, Cuerdon T (1997) A new look at evidence about reduced cost of medical utilization following mental health treatment. 1984. J Psychother Pract Res 7(1):68–86, discussion 65–67

    CAS  PubMed  Google Scholar 

  12. Sobel DS (1995) Rethinking medicine: improving health outcomes with cost-effective psychosocial interventions. Psychosom Med 57(3):234–244

    CAS  PubMed  Google Scholar 

  13. Holland JC, Bultz BD, National comprehensive Cancer N (2007) The NCCN guideline for distress management: a case for making distress the sixth vital sign. J Natl Compr Cancer Netw 5(1):3–7

    Google Scholar 

  14. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12(2):160–174

    Article  PubMed  Google Scholar 

  15. Miller K, Massie MJ (2006) Depression and anxiety. Cancer J 12(5):388–397

    Article  CAS  PubMed  Google Scholar 

  16. Stiefel F, Die Trill M, Berney A, Olarte JM, Razavi A (2001) Depression in palliative care: a pragmatic report from the Expert Working Group of the European Association for Palliative Care. Support Care Cancer 9(7):477–488

    Article  CAS  PubMed  Google Scholar 

  17. Potash M, Breitbart W (2002) Affective disorders in advanced cancer. Hematol Oncol Clin N Am 16(3):671–700

    Article  Google Scholar 

  18. Lawrie I, Lloyd-Williams M, Taylor F (2004) How do palliative medicine physicians assess and manage depression. Palliat Med 18:234–238

    Article  PubMed  Google Scholar 

  19. Breitbart W (1995) Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer 3:45–60

    Article  CAS  PubMed  Google Scholar 

  20. Jacobsen PB, Jim HS (2008) Psychosocial interventions for anxiety and depression in adult cancer patients: achievements and challenges. CA Cancer J Clin 58(4):214–230

    Article  PubMed  Google Scholar 

  21. Rayner L, Price A, Evans A, Valsraj K, Higginson IJ, Hotopf M (2010) Antidepressants for depression in physically ill people. Cochrane Database Syst Rev 3, CD007503

    PubMed  Google Scholar 

  22. Price A, Hotopf M (2009) The treatment of depression in patients with advanced cancer undergoing palliative care. Curr Opin Support Palliat Care 3(1):61–66

    Article  PubMed  Google Scholar 

  23. Li M, Fitzgerald P, Rodin G (2012) Evidence-based treatment of depression in patients with cancer. J Clin Oncol 30(11):1187–1196

    Article  PubMed  Google Scholar 

  24. Strong V, Waters R, Hibberd C, Murray G, Wall L, Walker J, McHugh G, Walker A, Sharpe M (2008) Management of depression for people with cancer (SMaRT oncology 1): a randomised trial. Lancet 372(9632):40–48

    Article  PubMed  Google Scholar 

  25. Rayner L, Price A, Hotopf M, Higginson IJ (2011) The development of evidence-based European guidelines on the management of depression in palliative cancer care. Eur J Cancer 47(5):702–712

    Article  PubMed  Google Scholar 

  26. Thisayakorn P, Weckmann MT (2013) Symptom screening in palliative care patients. J Palliat Med 16(4):338

    Article  PubMed  Google Scholar 

  27. Rhondali W, Perceau E, Saltel P, Trillet-Lenoir V, Blay JY, Fournel-Federico C, Coulon JP, Tredan O, Terra JL, Matillon Y, Bruera E, Filbet M (2012) Depression assessment by oncologists and palliative care physicians. Palliat Support Care:1–9

  28. Jacobsen PB, Ransom S (2007) Implementation of NCCN distress management guidelines by member institutions. J Natl Compr Cancer Netw 5(1):99–103

    Google Scholar 

  29. Donovan KA, Jacobsen PB (2013) Progress in the implementation of NCCN guidelines for distress management by member institutions. J Natl Compr Cancer Netw 11(2):223–226

    Google Scholar 

  30. Bruera E, Michaud M, Vigano A, Neumann CM, Watanabe S, Hanson J (2001) Multidisciplinary symptom control clinic in a cancer center: a retrospective study. Support Care Cancer 9(3):162–168

    Article  CAS  PubMed  Google Scholar 

  31. Strasser F, Sweeney C, Willey J, Benisch-Tolley S, Palmer JL, Bruera E (2004) Impact of a half-day multidisciplinary symptom control and palliative care outpatient clinic in a comprehensive cancer center on recommendations, symptom intensity, and patient satisfaction: a retrospective descriptive study. J Pain Symptom Manag 27(6):481–491

    Article  Google Scholar 

  32. Delgado-Guay MO, Parsons HA, Li Z, Palmer LJ, Bruera E (2009) Symptom distress, interventions, and outcomes of intensive care unit cancer patients referred to a palliative care consult team. Cancer 115(2):437–445

    Article  PubMed  Google Scholar 

  33. Elsayem A, Bruera E (2008) The M.D. Anderson symptom control and palliative care handbook. University of Texas M.D. Anderson Cancer Center, 166 pp

  34. McNicholl MP, Dunne K, Garvey A, Sharkey R, Bradley A (2006) Using the liverpool care pathway for a dying patient. Nurs Stand 20(38):46–50

    Article  PubMed  Google Scholar 

  35. Bruera E, MacMillan K, Hanson J, MacDonald RN (1989) The Edmonton staging system for cancer pain: preliminary report. Pain 37(2):203–209

    Article  CAS  PubMed  Google Scholar 

  36. Chang VT, Hwang SS, Feuerman M (2000) Validation of the Edmonton symptom assessment scale. Cancer 88(9):2164–2171

    Article  CAS  PubMed  Google Scholar 

  37. Richardson LA, Jones GW (2009) A review of the reliability and validity of the Edmonton symptom assessment system. Curr Oncol 16(1):55

    CAS  PubMed Central  PubMed  Google Scholar 

  38. Carvajal A, Centeno C, Watson R, Bruera E (2011) A comprehensive study of psychometric properties of the Edmonton symptom assessment system (ESAS) in Spanish advanced cancer patients. Eur J Cancer 47(12):1863–1872. doi:10.1016/j.ejca.2011.03.027

    Article  PubMed  Google Scholar 

  39. Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K (1991) The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J Palliat Care 7(2):6–9

    CAS  PubMed  Google Scholar 

  40. Cheung WY, Barmala N, Zarinehbaf S, Rodin G, Le LW, Zimmermann C (2009) The association of physical and psychological symptom burden with time to death among palliative cancer outpatients. J Pain Symptom Manag 37(3):297–304

    Article  Google Scholar 

  41. Ewing JA (1984) Detecting alcoholism. The CAGE questionnaire. JAMA 252(14):1905–1907

    Article  CAS  PubMed  Google Scholar 

  42. Liskow B, Campbell J, Nickel EJ, Powell BJ (1995) Validity of the CAGE questionnaire in screening for alcohol dependence in a walk-in (triage) clinic. J Stud Alcohol 56(3):277–281

    CAS  PubMed  Google Scholar 

  43. Swarm R, Abernethy AP, Anghelescu DL, Benedetti C, Blinderman CD, Boston B, Cleeland C, Coyle N, deLeon-Casasola OA, Eilers JG, Ferrell B, Janjan NA, Karver SB, Levy MH, Lynch M, Moryl N, Murphy BA, Nesbit SA, Oakes L, Obbens EA, Paice JA, Rabow MW, Syrjala KL, Urba S, Weinstein SM (2010) Adult cancer pain. J Natl Compr Cancer Netw 8(9):1046–1086

    Google Scholar 

  44. Yennurajalingam S, Atkinson B, Masterson J, Hui D, Urbauer D, Tu SM, Bruera E (2012) The impact of an outpatient palliative care consultation on symptom burden in advanced prostate cancer patients. J Palliat Med 15(1):20–24

    Article  PubMed  Google Scholar 

  45. Joly F, Vardy J, Pintilie M, Tannock IF (2007) Quality of life and/or symptom control in randomized clinical trials for patients with advanced cancer. Ann Oncol 18(12):1935–1942

    Article  CAS  PubMed  Google Scholar 

  46. Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL (2000) Defining the clinically important difference in pain outcome measures. Pain 88(3):287–294

    Article  CAS  PubMed  Google Scholar 

  47. Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM (2001) Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94(2):149–158

    Article  CAS  PubMed  Google Scholar 

  48. Bagha SM, Macedo A, Jacks LM, Lo C, Zimmermann C, Rodin G, Li M (2013) The utility of the Edmonton symptom assessment system in screening for anxiety and depression. Eur J Cancer Care 22(1):60–69

    Article  CAS  Google Scholar 

  49. Rhondali W, Perceau E, Berthiller J, Saltel P, Trillet-Lenoir V, Tredan O, Coulon JP, Bruera E, Filbet M (2012) Frequency of depression among oncology outpatients and association with other symptoms. Support Care Cancer 20(11):2795–2802

    Article  PubMed  Google Scholar 

  50. Delgado-Guay M, Yennurajalingam S, Parsons H, Palmer JL, Bruera E (2011) Association between self-reported sleep disturbance and other symptoms in patients with advanced cancer. J Pain Symptom Manag 41(5):819–827

    Article  Google Scholar 

  51. Delgado-Guay M, Parsons HA, Li Z, Palmer JL, Bruera E (2009) Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Support Care Cancer 17(5):573–579

    Article  PubMed  Google Scholar 

  52. van der Meulen IC, May AM, Ros WJ, Oosterom M, Hordijk GJ, Koole R, de Leeuw JR (2013) One-year effect of a nurse-led psychosocial intervention on depressive symptoms in patients with head and neck cancer: a randomized controlled trial. Oncologist 18(3):336–344

    Article  PubMed  Google Scholar 

  53. Hart SL, Hoyt MA, Diefenbach M, Anderson DR, Kilbourn KM, Craft LL, Steel JL, Cuijpers P, Mohr DC, Berendsen M, Spring B, Stanton AL (2012) Meta-analysis of efficacy of interventions for elevated depressive symptoms in adults diagnosed with cancer. J Natl Cancer Inst 104(13):990–1004

    Article  PubMed Central  PubMed  Google Scholar 

  54. Knobf MT, Thompson AS, Fennie K, Erdos D (2013) The effect of a community-based exercise intervention on symptoms and quality of life. Cancer Nurs. doi:10.1097/NCC.0b013e318288d40e

  55. Rodin G, Walsh A, Zimmermann C, Gagliese L, Jones J, Shepherd FA, Moore M, Braun M, Donner A, Mikulincer M (2007) The contribution of attachment security and social support to depressive symptoms in patients with metastatic cancer. Psychooncology 16(12):1080–1091

    Article  PubMed  Google Scholar 

  56. Salvo N, Zeng L, Zhang L, Leung M, Khan L, Presutti R, Nguyen J, Holden L, Culleton S, Chow E (2012) Frequency of reporting and predictive factors for anxiety and depression in patients with advanced cancer. Clin Oncol 24(2):139–148

    Article  CAS  Google Scholar 

  57. Kang JH, Kwon JH, Hui D, Yennurajalingam S, Bruera E (2013) Changes in symptom intensity among cancer patients receiving outpatient palliative care. J Pain Symptom Manag 46(5):652–660. doi:10.1016/j.jpainsymman.2012.11.009

    Article  Google Scholar 

  58. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742

    Article  CAS  PubMed  Google Scholar 

  59. Vignaroli E, Pace EA, Willey J, Palmer JL, Zhang T, Bruera E (2006) The Edmonton symptom assessment system as a screening tool for depression and anxiety. J Palliat Med 9(2):296–303

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Preparation of this manuscript is supported in part by the MD Anderson Cancer Center support grant CA 016672, the American Cancer Society (RSG-11-170-01-PCSM) [S.Y.], and the National Institutes of Health grants R01NR010162-01A1, R01CA1222292.01, and R01CA124481-01 [E.B.].

Conflict of interest

The authors made no disclosures. Dr. Bruera has full control of all primary data and he agrees to allow the journal to review these data if requested.

Author information

Authors and Affiliations

  1. Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 1414, Houston, TX, 77030, USA

    Wadih Rhondali, Sriram Yennurajalingam & Eduardo Bruera

  2. Department of Palliative Care, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, 164 chemin du Grand Revoyet, 69495, Pierre Bénite Cedex, Lyon, France

    Wadih Rhondali & Marilene Filbet

  3. Department of Palliative Care, Lyndon Baines Johnson General Hospital, Houston, TX, 77026, USA

    Jeanette Ferrer

  4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 1411, Houston, TX, 77030, USA

    Gary Chisholm

Authors
  1. Wadih Rhondali
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sriram Yennurajalingam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeanette Ferrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gary Chisholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marilene Filbet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eduardo Bruera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eduardo Bruera.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rhondali, W., Yennurajalingam, S., Ferrer, J. et al. Association between supportive care interventions and patient self-reported depression among advanced cancer outpatients. Support Care Cancer 22, 871–879 (2014). https://doi.org/10.1007/s00520-013-2042-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-013-2042-x

Keywords

Search

Navigation