Screening for untreated depression in cancer patients: a Japanese experience

Hironobu Inoguchi; Ken Shimizu; Haruki Shimoda; Kazuhiro Yoshiuchi; Tatsuo Akechi; Megumi Uchida; Asao Ogawa; Daisuke Fujisawa; Shinichiro Inoue; Yosuke Uchitomi

doi:10.1093/jjco/hyw104

Screening for untreated depression in cancer patients: a Japanese experience

Jpn J Clin Oncol. 2016 Nov 1;46(11):993-999. doi: 10.1093/jjco/hyw104.

Authors

Hironobu Inoguchi¹, Ken Shimizu¹, Haruki Shimoda^{2

3

4}, Kazuhiro Yoshiuchi⁵, Tatsuo Akechi^{6

7}, Megumi Uchida⁷, Asao Ogawa^{8

9}, Daisuke Fujisawa^{8

9}, Shinichiro Inoue¹⁰, Yosuke Uchitomi¹¹

Affiliations

¹ Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo.
² Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo.
³ Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo.
⁴ Department of Hygiene and Preventive Medicine, Iwate Medical University, Iwate.
⁵ Department of Stress Sciences and Psychosomatic Medicine, Graduate school of Medicine, The University of Tokyo, Tokyo.
⁶ Division of Palliative Care and Psycho-Oncology, Nagoya City University Hospital, Aichi.
⁷ Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi.
⁸ Division of Psycho-Oncology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Chiba.
⁹ Department of Psycho-Oncology Service, National Cancer Center Hospital East, Chiba.
¹⁰ Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama.
¹¹ Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan.

PMID: 27566975
DOI: 10.1093/jjco/hyw104

Abstract

Objective: Guidelines for supportive care in cancer patients have recommended routine psychological screening in clinical practice, and a Japanese national project has recommended screening for depression using the Distress and Impact Thermometer. However, a previous study advocating the validity of the Distress and Impact Thermometer may have overestimated its effectiveness, as the study included already-treated patients who were not screening targets. This study re-evaluated the performance and usefulness of the Distress and Impact Thermometer using an adequate sample size and appropriate study design.

Methods: Patients were consecutively recruited at two highly specialized hospitals and three university hospitals in Japan. Inclusion criteria were (i) undergoing aggressive anti-cancer treatment, (ii) the Eastern Cooperative Oncology Group performance status score <3 and (iii) age >20 years. Patients who were receiving psychiatric treatment were excluded from the study. After completing the Distress and Impact Thermometer, patients were evaluated with the gold-standard Composite International Diagnostic Interview by researchers who were blinded to the patients' Distress and Impact Thermometer scores.

Results: Forty-four patients (9%) who were receiving psychiatric treatment were excluded. Of 468 subjects included in the final analysis, only 3 had current depression (0.6%). Using cutoff points recommended by the previous study, the positive and negative predictive values were 0.02 and 0.99, respectively.

Conclusions: Our data indicated that screening for untreated depression in cancer patients was not useful in the specific clinical settings that were studied, and such screening should be implemented in appropriate contexts. Since there are no evidence-based recommendations regarding contexts in which psychological screening is essential, further research is needed.

Keywords: depression; diagnosis; neoplasms; psycho-oncology; questionnaires; sensitivity and specificity.