Division of Surgical Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Oncologist. 2020 Jul;25(7):e1098-e1108. doi: 10.1634/theoncologist.2019-0709. Epub 2020 Feb 26.
One of the most common psychological morbidities of cancer is depression. Routine depression symptoms screening (DSS) is recommended, but its ability to lead to psychosocial interventions in clinical practice is limited. We examined the use of and factors associated with psychosocial interventions for positive DSS following cancer diagnosis.
We conducted a population-based cohort study of patients with diagnoses from 2010 to 2017 who reported ≥1 patient-reported Edmonton Symptom Assessment System (ESAS) score. Positive DSS was defined as ESAS ≥2 out of 10 for the depression item within 6 months of diagnosis. Outcomes were psychosocial interventions around the time of positive DSS: palliative care assessment, psychiatry/psychology assessment, social work referral, and antidepressant therapy (in patients ≥65 years of age with universal drug coverage). We examined reduction in depression symptom score (≥1 point) following intervention. Modified Poisson regression examined factors associated with interventions.
Of 142,270 patients, 65,424 (46.0%) reported positive DSS at a median of 66 days (interquartile range: 34-105) after diagnosis. Of those with depression symptoms, 17.1% received palliative assessment, 1.7% psychiatry/psychology assessment, 8.4% social work referral, and 4.3% antidepressant therapy. Depression symptom score decreased in 67.2% who received palliative assessment, 63.7% with psychiatry/psychology assessment, 67.3% with social work referral, and 71.4% with antidepressant therapy. On multivariable analysis, patients with older age, rural residence, lowest income quintile, and genitourinary or oropharyngeal cancer were more likely to not receive intervention other than palliative care.
The proportion of patients reporting positive DSS after cancer diagnosis receiving psychosocial intervention is low. We identified patients vulnerable to not receiving interventions, who may benefit from additional support. These data represent a call to action to modify practice and optimize the usefulness of systematic symptom screening.
Patient-reported depression symptoms screening should be followed by targeted interventions to improve symptoms and patient-centered management.
癌症患者最常见的心理障碍之一是抑郁症。建议常规进行抑郁症状筛查（DSS），但它在临床实践中导致心理社会干预的能力有限。我们研究了癌症诊断后阳性 DSS 后使用和相关的心理社会干预措施。
我们对 2010 年至 2017 年期间报告有≥1 个患者报告的埃德蒙顿症状评估系统（ESAS）评分的患者进行了一项基于人群的队列研究。阳性 DSS 的定义为诊断后 6 个月内 ESAS 中抑郁项目≥2/10。阳性 DSS 时的心理社会干预措施为：姑息治疗评估、精神病学/心理学评估、社会工作转介和抗抑郁治疗（65 岁以上的患者有普遍药物覆盖）。我们检查了干预后抑郁症状评分（≥1 分）的降低情况。采用校正泊松回归分析了与干预相关的因素。
在 142270 名患者中，65424 名（46.0%）患者在诊断后中位数 66 天（四分位距：34-105）时报告有阳性 DSS。在有抑郁症状的患者中，17.1%接受了姑息评估，1.7%接受了精神病学/心理学评估，8.4%接受了社会工作转介，4.3%接受了抗抑郁治疗。接受姑息治疗评估的患者中 67.2%、接受精神病学/心理学评估的患者中 63.7%、接受社会工作转介的患者中 67.3%和接受抗抑郁治疗的患者中 71.4%的抑郁症状评分降低。多变量分析显示，年龄较大、居住在农村、收入最低五分位数和泌尿生殖或口咽癌患者更有可能不接受姑息治疗以外的干预措施。
癌症诊断后报告阳性 DSS 的患者接受心理社会干预的比例较低。我们确定了未接受干预的易受伤害的患者，他们可能需要额外的支持。这些数据代表了采取行动改变实践和优化系统症状筛查的有用性的呼吁。
患者报告的抑郁症状筛查后应进行针对性干预，以改善症状和以患者为中心的管理。
