Management of depression for people with cancer 4 (SMaRT oncology 1): a randomised trial

Vanessa Strong; Rachel Waters; Carina Hibberd; Gordon Murray; Lucy Wall; Jane Walker; Gillian McHugh; Andrew Walker; Michael Sharpe

doi:10.1016/S0140-6736(08)60991-5

Management of depression for people with cancer 4 (SMaRT oncology 1): a randomised trial

Vanessa Strong, Rachel Waters, Carina Hibberd, Gordon Murray, Lucy Wall, Jane Walker, Gillian McHugh, Andrew Walker, Michael Sharpe

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Abstract / Description of output

Background Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer, but evidence to guide its management is scarce. We aimed to assess the efficacy and cost of a nurse-delivered complex intervention that was designed to treat major depressive disorder in patients who have cancer.

Methods We did a randomised trial in a regional cancer Centre in Scotland, UK. 200 outpatients who had cancer with a prognosis of greater than 6 months and major depressive disorder (identified by screening) were eligible and agreed to take part. Their mean age was 56.6 (S D 11 . 9) years, and 141 (71%) were women. We randomly assigned 99 of these participants to usual care, and 101 to usual care plus the intervention, with minimisation for sex, age, diagnosis, and extent of disease. The intervention was delivered by a cancer nurse at the Centre over an average of seven sessions. The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale (range 0 to 4) at 3 months after randomisation. Analysis was by intention to treat. This trial is registered as ISRCTN84767225.

Findings Primary outcome data were missing for four patients. For 196 patients for whom we had data at 3 months, the adjusted difference in mean Symptom Checklist-20 depression score, between those who received the intervention and those who did not, was 0 . 34 (95% CI 0 . 13-0.55). This treatment effect was sustained at 6 and 12 months. The intervention also improved anxiety and fatigue but not pain or physical functioning. It cost an additional 5278 pound (U S $10 5 5 6) per quality-adjusted life-year gained.

Interpretation The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible, acceptable, and potentially cost effective.

Original language	English
Pages (from-to)	40-48
Number of pages	9
Journal	The Lancet
Volume	372
Issue number	9632
DOIs	https://doi.org/10.1016/S0140-6736(08)60991-5
Publication status	Published - 5 Jul 2008

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http://www.sciencedirect.com/science/article/pii/S0140673608609915

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@article{a6eb59874fe44c438031b660fae93ad2,

title = "Management of depression for people with cancer 4 (SMaRT oncology 1): a randomised trial",

abstract = "Background Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer, but evidence to guide its management is scarce. We aimed to assess the efficacy and cost of a nurse-delivered complex intervention that was designed to treat major depressive disorder in patients who have cancer. Methods We did a randomised trial in a regional cancer Centre in Scotland, UK. 200 outpatients who had cancer with a prognosis of greater than 6 months and major depressive disorder (identified by screening) were eligible and agreed to take part. Their mean age was 56.6 (S D 11 . 9) years, and 141 (71%) were women. We randomly assigned 99 of these participants to usual care, and 101 to usual care plus the intervention, with minimisation for sex, age, diagnosis, and extent of disease. The intervention was delivered by a cancer nurse at the Centre over an average of seven sessions. The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale (range 0 to 4) at 3 months after randomisation. Analysis was by intention to treat. This trial is registered as ISRCTN84767225. Findings Primary outcome data were missing for four patients. For 196 patients for whom we had data at 3 months, the adjusted difference in mean Symptom Checklist-20 depression score, between those who received the intervention and those who did not, was 0 . 34 (95% CI 0 . 13-0.55). This treatment effect was sustained at 6 and 12 months. The intervention also improved anxiety and fatigue but not pain or physical functioning. It cost an additional 5278 pound (U S $10 5 5 6) per quality-adjusted life-year gained. Interpretation The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible, acceptable, and potentially cost effective.",

author = "Vanessa Strong and Rachel Waters and Carina Hibberd and Gordon Murray and Lucy Wall and Jane Walker and Gillian McHugh and Andrew Walker and Michael Sharpe",

year = "2008",

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language = "English",

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pages = "40--48",

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T1 - Management of depression for people with cancer 4 (SMaRT oncology 1)

T2 - a randomised trial

AU - Strong, Vanessa

AU - Waters, Rachel

AU - Hibberd, Carina

AU - Murray, Gordon

AU - Wall, Lucy

AU - Walker, Jane

AU - McHugh, Gillian

AU - Walker, Andrew

AU - Sharpe, Michael

PY - 2008/7/5

Y1 - 2008/7/5

N2 - Background Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer, but evidence to guide its management is scarce. We aimed to assess the efficacy and cost of a nurse-delivered complex intervention that was designed to treat major depressive disorder in patients who have cancer. Methods We did a randomised trial in a regional cancer Centre in Scotland, UK. 200 outpatients who had cancer with a prognosis of greater than 6 months and major depressive disorder (identified by screening) were eligible and agreed to take part. Their mean age was 56.6 (S D 11 . 9) years, and 141 (71%) were women. We randomly assigned 99 of these participants to usual care, and 101 to usual care plus the intervention, with minimisation for sex, age, diagnosis, and extent of disease. The intervention was delivered by a cancer nurse at the Centre over an average of seven sessions. The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale (range 0 to 4) at 3 months after randomisation. Analysis was by intention to treat. This trial is registered as ISRCTN84767225. Findings Primary outcome data were missing for four patients. For 196 patients for whom we had data at 3 months, the adjusted difference in mean Symptom Checklist-20 depression score, between those who received the intervention and those who did not, was 0 . 34 (95% CI 0 . 13-0.55). This treatment effect was sustained at 6 and 12 months. The intervention also improved anxiety and fatigue but not pain or physical functioning. It cost an additional 5278 pound (U S $10 5 5 6) per quality-adjusted life-year gained. Interpretation The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible, acceptable, and potentially cost effective.

AB - Background Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer, but evidence to guide its management is scarce. We aimed to assess the efficacy and cost of a nurse-delivered complex intervention that was designed to treat major depressive disorder in patients who have cancer. Methods We did a randomised trial in a regional cancer Centre in Scotland, UK. 200 outpatients who had cancer with a prognosis of greater than 6 months and major depressive disorder (identified by screening) were eligible and agreed to take part. Their mean age was 56.6 (S D 11 . 9) years, and 141 (71%) were women. We randomly assigned 99 of these participants to usual care, and 101 to usual care plus the intervention, with minimisation for sex, age, diagnosis, and extent of disease. The intervention was delivered by a cancer nurse at the Centre over an average of seven sessions. The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale (range 0 to 4) at 3 months after randomisation. Analysis was by intention to treat. This trial is registered as ISRCTN84767225. Findings Primary outcome data were missing for four patients. For 196 patients for whom we had data at 3 months, the adjusted difference in mean Symptom Checklist-20 depression score, between those who received the intervention and those who did not, was 0 . 34 (95% CI 0 . 13-0.55). This treatment effect was sustained at 6 and 12 months. The intervention also improved anxiety and fatigue but not pain or physical functioning. It cost an additional 5278 pound (U S $10 5 5 6) per quality-adjusted life-year gained. Interpretation The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible, acceptable, and potentially cost effective.

U2 - 10.1016/S0140-6736(08)60991-5

DO - 10.1016/S0140-6736(08)60991-5

M3 - Article

SN - 0140-6736

VL - 372

SP - 40

EP - 48

JO - The Lancet

JF - The Lancet

IS - 9632

ER -

Management of depression for people with cancer 4 (SMaRT oncology 1): a randomised trial

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