Lloyd-Williams, M., Payne, S., Reeve, J., & Kolamunnage Dona, R. (2013). Antidepressant medication in patients with advanced cancer: An observational study. QJM, 106, 995–1001. 

To observe the longitudinal effects of antidepressant medication in a cohort of patients with advanced cancer

Of the 628 patients with advanced cancer in the study, 25% were receiving antidepressants for a median of 9.5 weeks. Patients were followed for six months or until death. Consecutive patients in the daycare unit were eligible for inclusion. Patients completed study assessments at baseline and at eight, 16, and 24 weeks. A patient self-report was used to identify patients taking antidepressants.

• N = 628  
• AVERAGE AGE = 66
• MALES: 33%, FEMALES: 67%
• KEY DISEASE CHARACTERISTICS: Advanced cancer; any tumor type
• OTHER KEY SAMPLE CHARACTERISTICS: Enrolled in hospice

• SITE: Multi-site    
• SETTING TYPE: Outpatient    
• LOCATION: Hospice day units, northwest England

• PHASE OF CARE: End-of-life care
• APPLICATIONS: Elder care and palliative care 

Observational

• Patient Health Questionnaire (PHQ-9) 
• Edinburgh Depression Scale (EDS)

Patients who stated that they took antidepressants had significantly higher depression scores on both measures. A subgroup analysis was completed for those with the highest PHQ-9 scores, assuming that effects might be seen in those with greater depression levels. However, there were no differences in results between those taking and not taking antidepressants.

The observational findings of this study suggest that antidepressant medication had little impact in reducing depression scores for patients attending Hospice daycare service.

• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Risk of bias (sample characteristics)
• Key sample group differences that could influence results
• Other limitations/explanation: Hospice day treatment; other treatments in use as well as antidepressants; difficult to determine what was the cause of change; patient self-report only used to identify those taking antidepressants and was not corroborated with medical records or any other source information

This observational study did not show that antidepressants reduced depression among patients receiving Hospice care. However, there were several study design and measurement limitations. The role and effectiveness of antidepressants may vary among patients at different phases in the trajectory of cancer.