Feb 01, 2016
By Shira Klapper, Senior Writer/Editor
A recent study published online, ahead of print, January 19, in the Journal of Oncology Practice (JOP) found that among 125 women who had been diagnosed with stage 0-IV breast cancer within the last 5 years:
- 60.4% were willing to accept an antidepressant from an oncologist and only 26.3% preferred treatment from a mental health professional.
- Among the 60.4% of women who were willing to accept an antidepressant from an oncologist, 77.3% reported no preference for an oncologist versus a mental health professional, or reported that treatment by a mental health professional did not matter.
- Participants already taking antidepressants or reporting high chronic stress preferred treatment from a mental health professional.
The study, “Would Women with Breast Cancer Prefer to Receive an Antidepressant for Anxiety or Depression from their Oncologist?” was published online, ahead of print on January 19. Study participants ranged in age from 26 to 84 years, with an average age of 55.36 years.
Daniel C. McFarland, DO, the study’s first author and an Instructor in the Department of Medicine at Memorial Sloan Kettering Cancer Center, said the study’s findings “provide more evidence for the basis of integrating mental health treatment into oncology care, although the findings need to be replicated.”
Addressing barriers to treatment
Anxiety and depression are common conditions among patients receiving treatment for breast cancer and other types of cancer. To address the need to treat these mental health conditions, in 1997 the National Comprehensive Cancer Network released standards of care for distress management, and in 2014 ASCO issued “Screening, Assessment, and Care of Anxiety and Depressive Symptoms in Adults With Cancer: An American Society of Clinical Oncology Guideline Adaptation.” However, research suggests that patients with cancer often do not receive adequate care for depression and anxiety.
One possible reason for this gap in care among patients with cancer is that current practices for delivering mental health care do not align with patients’ preferences. According to Dr. McFarland, “Few studies have looked at the question of patient preference.”
Dr. McFarland explained how current clinical practices might make it difficult for patients to pursue mental health care.
“In general, patients seem to find that the referral to mental health is cumbersome, especially during active cancer treatments. One reason for this could be that the depression or anxiety itself works against that referral materializing into an active mental health treatment. Understanding how patients want to receive their treatment is important for providing patient-centered care and for reaching patients who would otherwise never receive any psychological care. A patient who receives care according to his or her preferences is more likely to fully engage in the treatment, which is essential for any mental healthcare treatment. An understanding of our patients’ preferences should influence how we practice and the underlying system in which we practice.”
Integrating mental health care into oncology
According to the study in JOP, one model for integrating mental health care into cancer care is to teach oncologists how to initiate and manage treatment on their own. In a second model, a dedicated psychiatrist could collaborate with the oncology team, educating nurses, palliative care doctors, and others about anxiety and depression among patients with cancer. The psychiatrist would also provide regular guidance on best choices for antidepressants and assist with more complicated patients.
“Recent seminal work by Michael Sharpe and Jane Walker, investigators on the SMART trials, has shown that the treatment of depression and/or anxiety by the cancer team can be very effective while guided by mental health professionals in a collaborative manner,” said Dr. McFarland. “Our study shows that patients with breast cancer may want to be treated for depression and/or anxiety in the same manner that was demonstrated in the SMART trials.”
Treatment provided directly by oncologists would also make it more likely that any depression or anxiety is caught early on, an important factor considering that patients are most symptomatic during the first year of treatment, when they must make stressful decisions.
From Dr. McFarland’s perspective, the study’s findings generate questions that can lead to improved mental health care for patients with cancer. “For me, our study leads to more questions that need to be answered about patient preference. Ultimately, understanding these preferences may help us to ask the right questions to meet our patients’ needs during the clinical encounter.”
Daniel C. McFarland, DO, is an Instructor in the Department of Medicine at Memorial Sloan Kettering Cancer Center in New York City.
Abstract of the original JOP article.
PDF of the original JOP article.
McFarland DC, Shen M, Harris K, et al. Would women with breast cancer prefer to receive an antidepressant for anxiety or depression from their oncologist? J Oncol Pract. Epub 2015 TBD.
The Exclusive Coverage series on ASCO.org highlights selected research from JCO, JOP, and JGO, with additional perspective provided by the lead or corresponding author.
@ 2016 American Society of Clinical Oncology