Researchers address depression in cancer patients from underserved communities through a successful care program

According to recent research, about one in four cancer patients experience depression. For people from underserved and minority communities, that probability increases due to limited access to mental health care coupled with greater healthcare needs at diagnosis. 

Through a single-arm study of 141 cancer patients published in the Journal of Psychosocial Oncology and supported by a grant from the Merck Foundation Alliance to Advance Patient-Centered Cancer Care, University of Arizona Cancer Center researchers found that engaging a diverse population of cancer patients in a 12-week depression program, with a four-session minimum, provided a 65% improvement in their depression and quality of life. 

“We know that when people can reduce their depressive symptoms, they can become more active members of their treatment team and have better interactions with their family and their care providers.” 

 Heidi Hamann, PhD

Their results did not differ by ethnicity, cancer stage, income or education. They also found that through the depression education, therapy and medication, cancer patients saw improvement in suicidal thoughts, depression, anxiety, sleep disturbance and social isolation. 

According to lead researcher Karen Weihs, MD, professor in the Department of Psychiatry and UArizona Cancer Center (UACC) member, cancer patients who are depressed have a decreased ability to get back to work. 

“They're also less adherent to their cancer treatment, especially if they're on some of the long-standing treatments, like women on tamoxifen for five years, but just not as likely to be able to hang in there with all the treatments if they're depressed,” Weihs said. “That compromises the likelihood of having a full recovery. There is more and more evidence in the last 15 years that mortality rates are higher for cancer patients who are persistently depressed.”

Starting with a successful system

According to Weihs, the researchers created their program called Collaborative Oncology Project to Enhance Depression Care, or COPE-D, from a study designed by the University of Washington Center for Clinical Investigation. By using a well-established program, the researchers were able to offer the treatment to all patients in the study. They evaluated the feasibility, acceptability, and outcomes of their collaborative care intervention.

“There's very good evidence that when we use the population-oriented model beginning with screening for depression in every patient, followed by intervention, we can greatly enhance the number of women and men we identify and treat for depression,” Weihs said. 

As the only NCI-designated comprehensive cancer center headquartered in Arizona, UACC serves a large catchment area that includes patients who are from rural areas, of low socioeconomic status, older and from Spanish-speaking only populations. Researchers used bilingual care managers to meet the needs of their patients.

“Meeting the needs of patients in our cancer center catchment area is a very important priority,” said Heidi Hamann, PhD, associate professor in the Department of Psychology and co-leader of the Cancer Prevention and Control Program at the UACC. “Being in southern Arizona, we have an opportunity to work and interact with individuals from diverse backgrounds. Some are traveling very far to receive their care and others may face communication barriers. We should be responsive to those considerations in order to help them navigate their care.”

Weihs said the first step in their study was to identify cancer patient with depression through an assessment interview with a counselor called a care manager. The care manager worked closely with the oncologist, patient and psychiatrist to assess the patient’s needs and to develop a full treatment plan for the patient.

“Of course, it was the patient's choice,” Weihs said. “Do they want to undertake counseling? Do they want to undertake medication for depression?  Would they want to just start with changing some things in their lifestyle, like having some more pleasant activities?”

If the patient chose counseling, they attended weekly counseling session for four weeks. If their plan was working, they progressed to monthly visits. According to Hamann, they also offered the intervention by phone to assure the care team was responsive to the needs of their patients. Patients whose symptoms did not improve after several treatment modifications were referred to longer-term treatment.

“When you're diagnosed with cancer, oftentimes information comes at you very quickly,” Hamann said. “There are a lot of decisions to make, and it's really important to have a team around you who's caring for you, including your mental health, which is so crucial in terms of how people are responding to cancer.”

Weihs said that the publication’s first author Sarah Price, PhD, now a post-doctoral scholar at Wake Forest University, was invaluable to the project. 

“If it weren’t for Sarah, we wouldn't have collected the research data,” Weihs said.

Researchers found their study results of 65% of the enrolled study patients with significantly improved depression, far exceeded the 30% typical response rate to treatment for people with regular depression care at the Cancer Center.

“That difference between 30 and 65% is a big difference,” Weihs said. “It was such a success that we were able to encourage our Cancer Center leadership to continue the program, which is currently ongoing.” 

Weihs said the center’s cancer patients now have access to the COPE-D program with a permanent full-time counselor in addition to the patient’s social work team. She hopes the center continues to offer clinical depression management and psychosocial care for individuals who are diagnosed with cancer.

“We know that when people can reduce their depressive symptoms, they can become more active members of their treatment team and have better interactions with their family and their care providers,” Hamann said. “It helps their cancer prognosis as well.”