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The Royal College of Psychiatrists Improving the lives of people with mental illness

The Science of Psychiatry: Making an Impact

       

This piece of research was taken from 'Research and psychiatry - making an impact'

Treating depression in people with cancer

University
Edinburgh
Type of research
Translational
Topic
Depression
Impact on
Standards
Therapy type
 —
 

Some patients who have faced both cancer and depression have said that whilst recovering from cancer gives them their body back, it is only once they have also recovered from depression that they have their life back.

Medical science is getting ever better at treating cancer and there are estimates that around 2 million people in the UK are still alive after having had a cancer diagnosis. However, many of these people have not been cured, they are living with the disease and have to undergo continuing therapy. It is perhaps not surprising that many of these patients develop depression, but in many cases this was viewed by the medical community as just one of the many horrible features of cancer. It was not standard practice to consider whether they needed treatment.

Professor Michael Sharpe and colleagues at the Edinburgh Cancer Research Centre, Christie Hospital in Manchester and St Thomas’ Hospital in London ran a study to see how common it is for people with different types of cancer to develop depression and then to see how much of an impact they could make by embedding checks and treatments for depression within the standard cancer care.

First the team, including Research Nurse Vanessa Strong and Dr Lucy Wall, surveyed outpatients who were attending clinics at a cancer centre in Edinburgh. The researchers discovered there were several key attributes that made it more likely that patients would be under clinically significant levels of emotional stress. The data showed these attributes, which included being older than 65 and having an active disease but not yet a cancer diagnosis, could be used as warning flags that someone would be at higher risk of depression. The team used this information to show healthcare centres that they could focus on the people who were most likely to need care.

The researchers then designed and developed a system of care to diagnose and manage depression. They trained specialist members of the cancer care team and then embedded this system in the cancer centre. In order to test how effective their system was they devised a randomised controlled trial. This meant that patients would randomly be allocated to different types of care (usual treatment or with the added specialist care) and the researchers recorded how well people fared, without knowing which patients had been given which types of care.

Two hundred patients who had major depressive disorder and a cancer prognosis of more than 6 months volunteered to take part in the trial. The results were powerful - patients who had been given the specialist care had less depression and reported significantly better quality of life than those who had usual treatment. Using a medical intervention to make a difference as great as the one seen here would normally cost many tens of thousands of pounds per patient, but with this simple change of making sure that depression was treated at the same time as the cancer it cost just over £5,000.

In 2010 the organisation that creates health guidance for the UK, the National Institute for Health and Care Excellence (NICE), used the work from Sharpe’s team to change practice across the UK. Using the evidence to harness both psychiatry and oncology has meant a greater quality of life for thousands of patients and their families.

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