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Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial
Author(s) -
Wagner Lynne I.,
Pugh Stephanie L.,
Small William,
Kirshner Jeffrey,
Sidhu Kulbir,
Bury Martin J.,
DeNittis Albert S.,
Alpert Tracy E.,
Tran Binh,
Bloom Beatrice F.,
Mai Julie,
Yeh Alexander,
Sarma Kalika,
Becker Mark,
James Jennifer,
Bruner Deborah Watkins
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.29969
Subject(s) - medicine , patient health questionnaire , depression (economics) , distress , mood , radiation therapy , receiver operating characteristic , cancer , oncology , physical therapy , anxiety , psychiatry , clinical psychology , depressive symptoms , economics , macroeconomics
BACKGROUND Brief tools are needed to screen oncology outpatients for depressive symptoms. METHODS Patients starting radiotherapy for the first diagnosis of any tumor completed distress screening tools, including the 9‐item Patient Health Questionnaire (PHQ‐9), the 2‐item Patient Health Questionnaire (PHQ‐2), the National Comprehensive Cancer Network Distress Thermometer (NCCN‐DT), and the Hopkins Symptom Checklist (HSCL) (25‐item version). Patients exceeding validated cutoff scores and a systematic sample of patients whose screening was negative completed the Structured Clinical Interview for DSM‐IV (SCID) mood disorder modules via telephone. RESULTS Four hundred sixty‐three patients from 35 community‐based radiation oncology sites and 2 academic radiation oncology sites were recruited. Sixty‐six percent of the 455 eligible patients (n = 299) were women, and the eligible patients had breast (45%), gastrointestinal (11%), lung (10%), gynecologic (6%), or other cancers (27%). Seventy‐five (16.5%) exceeded screening cutoffs for depressive symptoms. Forty‐two of these patients completed the SCID. Another 37 patients whose screening was negative completed the SCID. Among the 79 patients completing the SCID, 8 (10.1%) met the criteria for major depression, 2 (2.5%) met the criteria for dysthymia, and 6 (7.6%) met the criteria for an adjustment disorder. The PHQ‐2 demonstrated good psychometric properties for screening for mood disorders with a cutoff score of ≥3 (receiver operating characteristic area under the curve [AUC], 0.83) and was comparable to the PHQ‐9 ( > 9; AUC = 0.85). The NCCN‐DT did not detect depression (AUC = 0.59). CONCLUSIONS The PHQ‐2 demonstrated good psychometric properties for screening for mood disorders, which were equivalent to the PHQ‐9 and superior to the NCCN‐DT. These findings support using the PHQ‐2 to identify patients in need of further assessment for depression, which has a low prevalence but is a clinically significant comorbidity. These findings could inform the implementation of distress screening accreditation standards. Cancer 2017;123:485–493. © 2016 American Cancer Society .