Nick Mulcahy

September 26, 2013

ATLANTA — A speedy, 2-question survey can effectively screen cancer patients for depression, according to research presented here at the American Society for Radiation Oncology 55th Annual Meeting.

The screening takes 1 or 2 minutes to administer, said lead study author William Small Jr., MD, chair of the Department of Radiation Oncology at Loyola University in Chicago.

The 2-item screen has "psychometric properties" that are equivalent or superior to other, longer depression screening tools analyzed in the study, he reported.

In other words, the quick quiz identified patients at risk for depression as well as or better than longer surveys did.

"This should be the standard of care" for cancer patients undergoing radiotherapy, Dr. Small said during a press briefing.

The screening "would be fairly easy to implement," said Bruce Haffty, MD, associate director of the Rutgers Cancer Institute of New Jersey in New Brunswick, who moderated the briefing.

Currently, no standard depression-specific screening tool is routinely used in these patients, said Dr. Haffty.

"Detection of depression in cancer patients is an important public health priority, and the ability to screen and treat cancer patients for depression can have a major impact on a patient's quality of life," Dr. Small said in a press statement.

In fact, cancer patients are more likely to complete therapy if they are not depressed, he added.

Two Questions as Good as 9

Dr. Small and colleagues discovered the effectiveness of the succinct survey, known as the Patient Health Questionaire-2 (PHQ-2), while evaluating various screening tools for depression in 455 patients undergoing or about to undergo radiotherapy at 37 centers in the United States.

All the study participants, who had a variety of cancer types and were mostly female (66%), completed the various screening questionnaires.

The questionnaires included the single-question National Comprehensive Cancer Network-Distress Thermometer (NCCN-DT), the Hopkins Symptom Checklist (HSCL-25), and the 9-item Patient Health Questionnaire (PHQ-9), the first 2 questions of which comprise the PHQ-2.

The PHQ-2 asks how often, in the past 2 weeks, the patient has felt "little interest or pleasure in doing things," and how often the patient has felt "down, depressed, or hopeless." The patients are given a score based on the frequency of their feelings.

Of the 455 study patients, 75 (16%) screened positive for depressive symptoms and were thus considered at risk for depression.

With the PHQ-9, 41 patients screened positive; with the PHQ-2, 36 did.

Patients who screened positive for depressive symptoms, along with a systematic sample of patients who screened negative, were administered the Structured Clinical Interview for DSM-IV (SCID) Mood Disorder modules by telephone.

Ultimately, the PHQ-2 and PHQ-9 demonstrated equally "good psychometric properties" for identifying a major depressive episode (receiver operating characteristic area under the curve was 0.83 for both). Both of these measures were superior to the HLSC-25 (0.79) and the NCCN-DT (0.60).

"PHQ-2 should be used to identify patients in need of further assessment and treatment for depression," the study authors conclude in their abstract.

Most sites participating in the study (78%) routinely screen patients for depression at their radiotherapy facility, and about half (51%) screen patients at their initial visit.

Although there were mental health services at 68% of the study sites, most sites (67%) had only social workers. Few had psychologists (17%) or psychiatrists (22%) to meet with depressed patients.

Dr. Small and Dr. Haffty have disclosed no relevant financial relationships.

American Society for Radiation Oncology (ASTRO) 55th Annual Meeting: Abstract 3. Presented September 23, 2013.

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