Veterans With Cancer Might Fall Under Radar for Depression

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Veterans with cancer sometimes do not undergo depression screening — a first step in easing the turmoil of possibly their hardest-fought battle.

While staff at the Indianapolis VA Medical Center screened 95 percent of veterans in primary care for depression, they screened cancer patients less consistently, according to a study in the November-December issue of the journal General Hospital Psychiatry.

Results varied depending on the cancer type, according to co-authors Laura E. Jones, Ph.D., an epidemiologist at the medical center, and Caroline Carney Doebbeling, M.D., a psychiatrist and internist at the Indiana University School of Medicine.

The researchers found that 1,083 out of 1,553 cancer patients underwent screening for depression. Nevertheless, while 82 percent of veterans with male-genital cancers underwent screening, only 51 percent of veterans with respiratory cancers did.

“When doctors think [patients] have a higher risk of mortality, depression screening is not as big a focus,” Jones said. Important steps are simply “making clinicians aware of it and making sure they realize it could be improved.”

The authors found that annual depression screening among veterans with cancer has improved: 42 percent underwent screening at the facility in 2000 compared with 81 percent in 2003. On average, 10 percent to 25 percent of cancer patients experience depression, a rate four times higher than the general population.

Jones and Doebbeling believe that treatment for depression will improve quality of life, and write that untreated depression in cancer patients could result in “disability, impaired quality of life, poor prognosis and increased risk of mortality, although the evidence is controversial.”

To be sure, an underlying debate continues over whether treating the psyche can help heal the body.

A study in the December issue of Cancer, a journal of the American Cancer Society, found that a patient’s emotional status does not influence cancer survival. The study reported that emotional well-being alone was not a factor affecting the prognosis of head and neck cancers.

“There is the important question of whether screening actually improves outcomes. In this case, does it reduce depression?” asked James Coyne, author of the Cancer study.

Effective treatment of depression has a number of components, said Coyne, director of the Behavioral Oncology Program at the University of Pennsylvania Abramson Cancer Center.

“I think the risk is that because screening uses up resources, these resources will be withdrawn from other activities, like effectively following up on patients whom we already know are depressed. I do not think that there is evidence that screening improves the outcome of depression without making substantially more resources available,” Coyne said.

He said that the Indianapolis VA study shows a high rate of screening and that the more pressing challenge is “keeping treatment of depression as a priority in the face of the competing demands of dealing with a life-threatening illness: cancer.”

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, MD, at (206) 543-7177.

Jones LE, Carney Doebbeling C. Suboptimal depression screening following cancer diagnosis. Gen Hosp Psychiatry 29(6), 2007.

Source: Health Behavior News Service

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