Depression in cancer may be prevented and effectively treated using safe interventions that won’t interfere with oncological treatment, according to study results published in the Journal of Psychiatric Research.
The prevalence of depression in cancer is higher than that among the general population; however, depression in cancer remains both underdiagnosed and undertreated. Researchers hypothesize that prophylactic treatment of depression within the first month after diagnosis may aid in prevention. The objective of this study was to assess the evidence of primary prophylactic depression treatment in cancer.
In this systematic review, researchers searched 5 electronic databases to identify randomized controlled trials in which adult patients with cancer received antidepressant treatment of any kind, and in which depression and depressive symptoms were the primary outcomes. The review was registered on PROSPERO and reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.
The primary outcome of this particular review was the prevention of depression and/or depressive symptoms, regardless of whether or not they were assessed as primary or exploratory outcomes in the studies. All studies included in this review were classified into 3 groups based on the type of intervention: pharmacological, psychotherapeutic, and other types of interventions. The final qualitative synthesis included 18 randomized controlled trials published between 1996 and 2017.
Results revealed that in the 18 studies included, patients were predominantly women between the ages of 47 and 69, and breast cancer was the most common cancer. The majority of studies administered interventions for depression during active oncological treatment, and psychological assessments were conducted at baseline and at follow-up, which ranged between the time of discharge to more than 1 year after baseline.
Of the 18 studies, there were 7 that reported a statistically significant prophylactic effect on depression. The meta-analyses showed a significant treatment effect in favor of prophylactic pharmacological treatment (relative risk 0.34, 95% CI, 0.18-0.63), psychotherapeutic interventions (standardized mean difference -0.23, 95% CI, -0.46 to 0.00), and other prophylactic interventions (standardized mean difference -0.17, 95% CI, -0.31 to -0.03). One study involving melatonin treatment had overall low risk for bias, while the other studies had high risk for bias on behalf of factors including blinding, lack of data, and insufficient random allocation and concealment.
This study had several limitations. First, there was potential bias in the search, selection, and data extraction process. Second, only randomized controlled trials were included to result in a risk for publication bias. Researchers did not search trial registers or registers of authorities for unpublished trials, which could have resulted in oversights and inflated effect sizes in analyses. Lastly, researchers were only able to perform 3 broad meta-analyses, which increased the risk for statistically significant results by chance.
The study researchers concluded that although there is some evidence to support prophylactic treatment of depression in cancer, there remains no convincing evidence for any specific intervention, and that depression treatment should be provided during oncological treatment given the intervention won’t negatively interfere with cancer treatment.
Zahid JA, Grummedal O, Madsen MT, Gögenur I. Prevention of depression in patients with cancer: A systematic review and meta-analysis of randomized controlled trials. J Psychiatr Res. 2020;120:113-123.