Magazine article Clinical Psychiatry News

Oncology Nurses Reduce Depression in Cancer Patients

Magazine article Clinical Psychiatry News

Oncology Nurses Reduce Depression in Cancer Patients

Article excerpt

TUCSON, ARIZ. -- A psychiatric intervention conducted by specially trained oncology nurses significantly reduced depression for cancer patients enrolled in a clinical trial presented at the annual meeting of the Academy of Psychosomatic Medicine.

Dr. Michael Sharpe reported that patients randomized to problem-solving therapy reached lower mean scores on the Symptom Checklist-20 (SCL-20) and were more likely to achieve a 50% reduction in clinical symptoms, compared with patients given optimized usual care. The randomized group also had twice the rate of complete remission.

"That tells us we can make a difference in depression in cancer patients with this kind of model," said Dr. Sharpe, a professor of psychological medicine and symptoms research at the University of Edinburgh where the 200-patient trial was conducted.

Depression is common but poorly managed in cancer patients, according to Dr. Sharpe. It is associated with nonadherence to cancer treatment, increased medical costs, and suicide, he said. Yet it is often not detected or, if recognized, discounted as a normal response to having cancer.

"We still have the view of some primary care doctors that if you've got cancer, you've got depression--that it's normal," he said.

Therefore, the investigators recruited oncology nurses in an attempt to integrate depression care into cancer care. A psychiatrist supervised the nurses, who coordinated drug treatment, delivered psychological treatment, and monitored patient progress.

As described by Dr. Sharpe, the psychological component was a problem-solving therapy in which the patients would list cancer and noncancer concerns. They would choose one concern to focus on with the nurse, identifying what a solution would look like and brainstorming on how to achieve it. Next, they would choose and try out a strategy.

One nurse worked full time in a pilot study testing the model. A full day of depression and cancer care turned out to be "too much," Dr. Sharpe said. Therefore, nurses worked half-time in the randomized trial.

Selection and training of nurses without a psychiatric background was also a challenge. "We had problems. We recruited people who could not do it," Dr. Sharpe said. "We had a core of three nurses who did treatment. …

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