Walker, J., Sawhney, A., Hansen, C.H., Symeonides, S., Martin, P., Murray, G., & Sharpe, M. (2013). Treatment of depression in people with lung cancer: A systematic review. Lung Cancer (Amsterdam, Netherlands), 79(1), 46–53.

To determine, by using a systematic review, which, if any, treatments have been found to be effective in reducing depression in patients with lung cancer

• Authors consulted these databases: MEDLINE (1948–Oct. 1, 2011), EMBASE Classic and EMBASE (1947–week 41, 2011), PsycINFO (1806–week 2, 2011), CINAHL Plus (1937–October 2011), and the Cochrane Central Register of Controlled Trials. Search keywords were depression, lung cancer, treatment, and systematic review.
• In this randomized controlled trial, adults were 18 years old or older and had received a definite diagnosis of lung cancer.
• The trial evaluated the efficacy or effectiveness of a pharmacologic or nonpharmacologic intervention intended to improve patients’ symptoms or quality of life. Depression outcomes were assessed using a standardized measure.
• Excluded from the analysis were nonprimary publications for which the full paper could not be obtained for data extraction.

The total number of references retrieved was 143. The evaluation method consisted of the review, by two independent researchers, of full articles.

• The final number of studies included was six.
• The sample range, across studies, was 64–549.
• Patients in the largest sample were newly diagnosed or new to the clinic; those in the smallest sample had a prognosis of 3–12 months. Most were from ambulatory clinics. Some patients had early-stage disease and some had metastatic disease.
   

• Phase of care: multiple
• Application: eldercare

No trials aimed to evaluate the effectiveness of treatments for depression in people with lung cancer. The six trials in the sample discussed interventions intended to improve symptoms related to quality of life, and each trial included a measure of depression as a secondary measure. The interventions, depression measures, and time of measurement varied. The interventions included breathlessness advice and discussion, education about self-referral for local psychosocial resources, counseling, coping skills training (including progressive muscle relaxation and symptom management strategies), early introduction of palliative care, and supportive psychotherapy. Studies indicated that enhanced care was more effective in reducing depression symptoms than was standard care.

Patients with lung cancer tend to be older adults with medical comorbidities, and these patients tend to suffer severe physical deterioration. Although standard depression treatments may be a reasonable course for treating depressed people with lung cancer, no randomized controlled trials (RCTs) guide clinicians in treating this population.

• The review was not limited to interventions designed specifically to treat depression.
• Participants were not necessarily depressed at the time of trial enrollment.
• Reviewers found that reports of the procedures for participant recruitment and the collection of outcome data frequently lacked detail.

No evidence guides clinicians who are caring for this specific population; well-conducted RCTs are urgently needed. Analysis indicates that clinicians may consider, as tools to reduce depression, depression treatments effective in older adults in the general population and those with medical comorbidities.