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A team of Scottish researchers let shown that cancer patients offered a depression tutelage intervention - delivered by specially trained oncology nurses with no previous psychiatrical experience - showed improvements in symptoms of impression compared to patients offered usual concern. The beneficial effects of the "Depression Care for People with Cancer" parcel (DCPC) were found to be free burning at 12 months follow-up, to the surprise of the investigators.
Major depressive disorder severely impairs the quality of life of patients with medical disorders, such as cancer. Estimates suggest that clinical depression affects 10 % of patients with cancer. Few studies have, however, been undertaken to guide clinicians in the management of this type of low. Professor Michael Sharpe and colleagues, from the University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, Scotland, undertook the SMaRT (Symptoms Management Research Trials) oncology 1 trial to study the use of the DCPC package, that had been originally designed for the treatment of depression in basal care.
In the study, funded by Cancer Research UK, 200 patients - all with a cancer prognosis of more than six months (to control they could compete the trial) and major depression, were randomised to obtain the usual care of antidepressants and mental health referrals or usual care in addition to the DCPC programme. The patients were on average 56.6 years, and 71 % were women.
Patients allocated to the DCPC arm were offered an average of seven one-to-one consultations o'er three months with a specially-trained crab nurse. The sessions aimed to help patients to understand depression and its treatments, including antidepressants, and provided problem solving strategies to help patients overcome feelings of impuissance. The nurses also communicated with each patient's oncologist and primary care doctor about the direction of their depression. Following the initial treatment, the nurse monitored the patient's progress by telephone and provided optional booster roger Sessions if needed. Depression levels were mensurable using the self-reported Symptom Checklist-20 economic crisis scale (range 0 to 4), and also by interview at three, hexad, and 12 months for both groups. The nurses, who had no previous experience of psychiatry, were trained to deliver the intervention exploitation written materials, tutorials and supervised praxis over a period of at least three months. The principal outcome was the remainder in meanspirited score on the self-reported Symptom Checklist-20 depression scale (range 0 to 4) at trinity months with the analysis undertaken according to intention to treat.
Sharpe and colleagues found that patients world Health Organization received DCPC had a lower impression level - by 0.34 on the scale - than those wHO did non receive DCPC. The handling group also had a major economic crisis rate that was 23% lower than in the usual charge group. After 12 months, the benefits from the DCPC intercession were still evident. The DCPC intervention also improved anxiety and fatigue, just did not improve pain sensation or physical functioning.
DCPC treatment, call the researchers, has the potential to be extremely cost-effective. Over the six months DCPC cost �336 (US$668) per patient, which is eq to �5278 per quality-adjusted life-year gained. This is well inside that unremarkably considered to be price effective, compose the authors. They complete: "The intervention proved to be feasible to drive home, acceptable to the patients who received it and also cost effective in terms of the increase in quality-adjusted life-years achieved."
The limitations of the study, say the researchers, are that the physical symptoms of depression can buoy overlap with those caused by medical disorders, a potential bias in self-rated outcome assessments, and the generalisability of the findings since patients who had cancers with a pathetic prognosis and those with chronic depression pre geological dating the diagnosis, were excluded. In future studies, the team hope to investigate whether the programme is cost effective if enforced on a larger scale, and whether the interference might as well benefit patients who have cancers with a pitiable prognosis, such as lung cancer. The investigators likewise wish to explore whether quality of life might be improved if botheration were treated at the same time, and whether the approach might be effective for patients world Health Organization attend specialist services for other medical disorders.
In an accompanying commentary, Gary Rodin (Princess Margaret Hospital, University Health Network, Toronto, Canada), wrote: "In a well-designed study, Sharpe and colleagues have shown that trained nurses with no previous psychiatric experience can deliver a cost-effective collaborative psychosocial intervention for cancer patients with major depressive upset. Such multi-component interventions are potentially practicable in malignant neoplastic disease treatment centres and canful be sensed by patients as less stigmatising than referral to a mental health
