How Depression Treatment Affects Cancer Survival: SMaRT Oncology-2 and 3

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Improvement in depression was observed with the treatment program but there was no improvement in survival.

Although depression treatment for patients with cancer and comorbid major depression was demonstrated to improve quality of life, there was no evidence of an effect on survival, according to a recent study published in The Lancet Psychiatry.

Previous trials have indicated that psychological and psychiatric treatments improve cancer survival, but systematic reviews of these studies show major shortcomings. Although multiple studies indicate that comorbid depression is associated with lower cancer survival rates, none have examined the impact of depression treatment on survival. The present study set out to examine the effect of depression treatment on survival by following up on participants in the SMaRT Oncology-2 and SMaRT Oncology-3 trials, which examined the efficacy of the Depression Care for People with Cancer (DCPC) treatment program at 3 cancer centers and associated clinics in Scotland.

In the SMaRT Oncology trials, study participants were randomly assigned to standard care or DCPC in a 1:1 ratio with stratification by location, age, primary cancer, and sex. Staff and statisticians who collected data were masked, although clinicians and participants could not be due to DCPC protocols. Of the 642 total participants, 500 were included in the SMaRT Oncology-2 trial for good prognosis cancers (estimated ≥12 months survival) and 142 were included in the SMaRT Oncology-3 trial for poor prognosis lung cancer (≥3 months estimated survival). 

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For the purposes of the present study, investigators obtained follow-up data for a mean of 5.1 years for SMaRT Oncology-2 participants and 1.2 years for SMaRT Oncology-3 participants, finding that 27% of SMaRT Oncology-2 participants and 80% of SMaRT Oncology-3 participants had died during the respective time periods. No significant difference was found between the survival rates of subjects in the DCPC groups and the control groups.

Investigators conclude, “despite there being no notable effect on length of life, the beneficial effect of treatment of depression on quality of life provides sufficient reason to make this an important part of cancer care.”


Mulick A, Walker J, Puntis S, et al. Does depression treatment improve the survival of depressed patients with cancer? A long-term follow-up of participants in the SMaRT Oncology-2 and 3 trials [published online March 12, 2018]. Lancet Psychiatry. doi: 10.1016/S2215-0366(18)30061-0