Integrated management of major depression for people with cancer

Abstract

Major depression is an important complication of cancer. However, it is frequently inadequately treated. There are challenges both in identifying which cancer patients are depressed, and in ensuring that these patients receive effective treatment for their depression. Integration of depression management into cancer care has been advocated as a way to address these challenges. Such integrated approaches must include both the systematic identification of cases and the delivery of treatment. We describe here a system of depression care that includes both a screening programme to identify patients with depression and a linked treatment programme, based on the collaborative care model, called ‘Depression Care for People with Cancer’ (DCPC). The system of care was designed to be fully integrated with specialist cancer services and has been robustly evaluated in randomized trials. We describe how the system operates and explain why it is designed as it is. We also summarize the evidence for its effectiveness and cost-effectiveness and discuss its implementation in routine clinical practice.

Declaration of interest: This work was funded by Cancer Research UK as part of a programme grant (number C5547/A7375) with additional funding from the Chief Scientist Office of the Scottish Government. J.W. is supported by Sir Michael Sobell House Hospice, Oxford, and the NIHR Collaboration for Leadership in Applied Health Research and Care Oxford at Oxford NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. The authors alone are responsible for the content and writing of the paper.