Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial

• Type of Material: Article
• Authors: Lynne I. Wagner, Wake Forest School of Medicine; Stephanie L. Pugh, NRG Oncology Statistics and Data Management Center; William Small, Loyola University Chicago; Jeffrey Kirshner, Hematology-Oncology Associates of CNY CCOP; Kulbir Sidhu, Southeast Cancer Control Consortium CCOP; Martin J. Bury, Grand Rapid Clinical Oncology Program; Albert S. DeNittis, Maine Line CCOP; Tracy E. Alpert, Hematology-Oncology Associates of CNY CCOP; Binh Tran, Northern Indiana Cancer Research Consortium CCOP; Beatrice F. Bloom, North Shore University Hospital CCOP; Julie Mai, Mercy Hospital St. Louis; Alexander Yeh, St. Vincent Anderson Regional Hospital, Inc.; Kalika Sarma, Carle Cancer Center CCOP; Mark Becker, Columbus Community Clinical Oncology Program; Jennifer James, NRG Oncology Statistics and Data Management Center; Deborah W. Bruner, Emory University
• Language: English
• Date: 2017-02-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 American Cancer Society
• Final Published Version (URL): http://dx.doi.org/10.1002/cncr.29969
• Title of Journal or Parent Work: Cancer
• ISSN: 0008-543X
• Volume: 123
• Issue: 3
• Start Page: 485
• End Page: 493
• Grant/Funding Information: This project was supported by grants U10CA21661, U10CA180868, U10CA180822, and U10CA37422 from the National Cancer Institute.; This project was also funded in part by a grant from the Pennsylvania Department of Health.; The Department specifically declaims responsibility for any analyses, interpretations or conclusions.
• Keywords: STANDARD; PSYCHOSOCIAL CARE; depression screening; PREVALENCE; DISTRESS; METAANALYSIS; distress; Science & Technology; HEALTH; mood disorders; Oncology; depression; ITEM; distress screening; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Oncology

Abstract

BACKGROUND: Brief tools are needed to screen oncology outpatients for depressive symptoms. METHODS: Patients starting radiotherapy for the first diagnosis of any tumor completed distress screening tools, including the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), and the Hopkins Symptom Checklist (HSCL) (25-item version). Patients exceeding validated cutoff scores and a systematic sample of patients whose screening was negative completed the Structured Clinical Interview for DSM-IV (SCID) mood disorder modules via telephone. RESULTS: Four hundred sixty-three patients from 35 community-based radiation oncology sites and 2 academic radiation oncology sites were recruited. Sixty-six percent of the 455 eligible patients (n = 299) were women, and the eligible patients had breast (45%), gastrointestinal (11%), lung (10%), gynecologic (6%), or other cancers (27%). Seventy-five (16.5%) exceeded screening cutoffs for depressive symptoms. Forty-two of these patients completed the SCID. Another 37 patients whose screening was negative completed the SCID. Among the 79 patients completing the SCID, 8 (10.1%) met the criteria for major depression, 2 (2.5%) met the criteria for dysthymia, and 6 (7.6%) met the criteria for an adjustment disorder. The PHQ-2 demonstrated good psychometric properties for screening for mood disorders with a cutoff score of ≥3 (receiver operating characteristic area under the curve [AUC], 0.83) and was comparable to the PHQ-9 ( > 9; AUC = 0.85). The NCCN-DT did not detect depression (AUC = 0.59). CONCLUSIONS: The PHQ-2 demonstrated good psychometric properties for screening for mood disorders, which were equivalent to the PHQ-9 and superior to the NCCN-DT. These findings support using the PHQ-2 to identify patients in need of further assessment for depression, which has a low prevalence but is a clinically significant comorbidity. These findings could inform the implementation of distress screening accreditation standards. Cancer 2017;123:485–493. © 2016 American Cancer Society.