Depression in Many Cancer Patients May Go Undiagnosed

Four in 10 patients with cancer being treated at an urban cancer center had depression, the majority of which was previously undiagnosed, according to the results of a study (abstract 21) presented at the 59^th Annual Meeting of the American Society for Radiation Oncology (ASTRO), held September 24–27 in San Diego.

The National Cancer Institute estimates that 15% to 25% of the cancer patient population has depression-a rate two to three times that of the general population. Approximately 7% of US adults experience major depression, according to the National Institute of Mental Health.

“Depression prevalence continues to be high among cancer patients, especially those receiving treatment at an urban cancer center, as well as those who identify as female or are disabled by their disease,” said lead author Jason Domogauer, an MD/PhD candidate at Rutgers University New Jersey Medical School in Newark, New Jersey, in a press release. “Alarmingly, most of these patients remain undiagnosed and untreated, indicating an important gap in cancer care and an opportunity to improve patient outcomes.”

The study surveyed 400 cancer patients treated at the Radiation Oncology, Hematology/Oncology, and Chemotherapy Infusion Clinics at the University Hospital Cancer Center in Newark. The cohort was a mix of African American/black (n = 170), non-Hispanic white (n = 102), and Hispanic or Latino (n = 57). The researchers collected information on age, sex, race, educational level, income, and mental health treatment history. Patients were screened for depression using the Center for Epidemiologic Studies Depression Scale; a score of 16 or higher was considered positive for depression.

The overall prevalence for depression was 40%; 75% of these cases were not previously diagnosed. According to the researchers, this meant that about 30% of the patients at this cancer center suffered from undiagnosed and untreated depression.

There was no difference in the prevalence of depression based on racial ethnicity category. However, females were more likely to have depression than males (47% vs 32%; odds ratio [OR], 1.9; P = .007).

In addition, there was increased depression among those patients whose employment status was “unable to work” due to disability (OR, 1.9; P = .005).  Looking specifically at patients who were previously not diagnosed with depression, the effects of being female or unable to work persisted. Among this subgroup, depression was more common among women (43% vs 29% in men; OR 1.9, P = .02) and disabled patients who were unable to work (43% vs 31% able to work; OR, 1.9, P = .03).

“Depression is widely recognized as an underdiagnosed disorder, particularly among older adults and cancer patients,” Domogauer said. “Our findings point to a clear need for action including depression screening during initial and continuing patient visits, initiation of mental health treatments for identified patients and increased collaboration with mental health providers in cancer treatment centers.”