Li, M., Kennedy, E.B., Byrne, N., Gerin-Lajoie, C., Katz, M.R., Keshavarz, H., . . . Green, E. (2016). Management of depression in patients with cancer: A clinical practice guideline. Journal of Oncology Practice, 12, 747–756. 

DOI Link

Purpose & Patient Population

PURPOSE: This is an update of a previously published guideline that provided recommendations for the management of depression in adult patients with cancer.
 
TYPES OF PATIENTS ADDRESSED: Patients with cancer at various stages of treatment with suspected or diagnosed major depressive disorder

Type of Resource/Evidence-Based Process

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: A working group that involved experts in nursing, health research methodology, psychiatry, and psychology conducted the review. The project methodologist extracted data, and the project research assistant verified the data. The draft recommendations were reviewed by a panel of internal reviewers and external reviewers. Targeted peer review and professional consultation were also obtained, and the results were incorporated into the final guideline.
 
SEARCH STRATEGY: Search terms related to depression and cancer were used.
 
DATABASES USED: Websites of guideline developers, relevant cancer agencies, MEDLINE, and EMBASE
 
INCLUSION CRITERIA: Systematic reviews of randomized, controlled trials (RCTs) or single RCTs in the English language
 
EXCLUSION CRITERIA: Not mentioned

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care

Results Provided in the Reference

Several clinical practice guidelines and two meta-analyses of 21 RCTs and some integrative reviews were included. Guideline quality was assessed with the AGREE II instrument, and a systematic review quality was assessed with the Assessment of Multiple Systematic Reviews (AMSTAR) tool.

Guidelines & Recommendations

Evidence synthesis resulted in eight recommendations for the management of depression: 
  • Screening of patients with cancer for depression is very important to guide treatment.
  • Psychoeducation and providing information about the nature of depression and its impact in cancer outcomes are important. Optimizing cancer-related symptom management
  • Pharmacologic or psychosocial interventions either alone or in combination have beneficial effects.
  • A stepped care model that suggests low intensity interventions (i.e., physical activity programs, group-based peer support, and self-help programs) for mild -to-moderate depression and high-intensity interventions (i.e., group cognitive behavioral therapy, behavioral couples’ therapy, and individual or group supportive-expressive psychotherapies) for severe depression were recommended.
  • Collaborative care (active collaboration between the oncologist or primary care provider and a patient care manager nurse, social worker, or psychologist) should be considered.
  • Referral to psychosocial specialist when needed
  • Selection of psychological therapy should be based on patient factors and local resource availability. This recommendation is based in consensus. 
  • Antidepressants should be considered for severe depression, not for mild depression related to high risk–benefit ratio.

Limitations

Some recommendations were consensus-based.

Nursing Implications

A quick reference algorithm for the initial management of depression in patients with cancer and the stepped care model for delivering care interventions depending on the severity of depression are great tools nurses and other healthcare professionals can use in their clinical practice while managing depression.