Frequency of depression among oncology outpatients and association with other symptoms.

PURPOSE: Depression occurs among an estimated 15% of cancer patients (range, 1-77.5%). Our main objective was to identify the frequency of reported depression by using the Brief Edinburgh Depression Scale (BEDS) among cancer outpatients. Our secondary objective was to identify associated symptoms of cancer using the Edmonton Symptom Assessment System (ESAS) and to evaluate the screening performance of depression between ESAS and BEDS. METHODS: In this multicenter prospective study conducted, we used the ESAS to collect information on nine symptoms: pain, fatigue, nausea, depression, anxiety, drowsiness, shortness of breath, lack of appetite, and feeling of well-being (each rated from 0 to 10). The BEDS was used to assess for "probable depression" (score >6). Data were analyzed using a parametric and nonparametric test. RESULTS: A total of 146 patients completed the study. The prevalence of probable depression was 43/146 (29%). Probable depression was associated with increased fatigue (p = 0.008), depression (p < 0.0001), anxiety (p < 0.0001), shortness of breath (p = 0.01), and decreased feeling of well-being (p < 0.001). Among patients with probable depression, 42 (98%) patients were not using antidepressants. Regarding the sensitivity and the specificity, we determined that the optimal cutoff for using the ESAS as a depression screening tool was ≥ 2. CONCLUSION: We found significant associations between probable depression as determined with the BEDS and five symptoms as detected with the ESAS. The vast majority of patients with probable depression were not receiving pharmacological treatment. Depression should be suspected in patients with higher symptom distress as for any one of these 5 ESAS items.

Depression assessment by oncologists and palliative care physicians.

OBJECTIVE: Depression is a frequent problem in cancer patients, which is known to reduce quality of life; however, many cancer patients with depression are not treated because of the difficulties in assessing depression in this population. Our aim was to evaluate and improve the depression assessment strategies of palliative care (PC) physicians and oncologists. METHOD: We invited all medical oncologists and PC physicians from three cancer centers to participate in this multicenter prospective study. They were asked to classify 22 symptoms (related and specific to depression in cancer patients, related but not specific, and unrelated) as "very important," "important," "less important," or "not important" for the diagnosis of depression in cancer patients, at three different time points (at baseline, after a video education program, and after 4 weeks). They were also asked to complete a questionnaire exploring physicians' perceptions of depression and of their role in its systematic screening. RESULTS: All 34 eligible physicians participated. Baseline performance was good, with >70% of participants correctly classifying at least seven of nine related and specific symptoms. We found no significant improvement in scores in the immediate and 4-week follow-up tests. Additionally, 24 (83%) and 23 (79%) participants expressed support for systematic depression screening and a role for oncologists in screening, respectively. SIGNIFICANCE OF RESULTS: Oncologists had good baseline knowledge about depression's main symptoms in cancer patients and a positive attitude toward being involved in screening. Underdiagnosis of depression is probably related to problems associated with the oncology working environment rather than the physicians' knowledge.

[Audit: medical record documentation among advanced cancer patients]. / Audit : traçabilité de l'information dans la prise en charge de patients atteints de cancer en phase avancée.

Medical record documentation of cancer inpatients is a core component of continuity of care. The main goal of the study was an assessment of medical record documentation in a palliative care unit (PCU) using a targeted clinical audit based on deceased inpatients' charts. Stage 1 (2010): a clinical audit of medical record documentation assessed by a list of items (diagnosis, prognosis, treatment, power of attorney directive, advance directives). Stage 2 (2011): corrective measures. Stage 3 (2012): re-assessment with the same items' list after six month. Forty cases were investigated during stage 1 and 3. After the corrective measures, inpatient's medical record documentation was significantly improved, including for diagnosis (P = 0.01), diseases extension and treatment (P < 0.001). Our results highlighted the persistence of a weak rate of medical record documentation for advanced directives (P = 0.145).

[Translation and validation of Brief Edinburgh Depression Scale (BEDS) in French]. / Validation linguistique et métrique de la version française de la Brief Edinburgh Depression Scale (BEDS).

BACKGROUND: Depression is an important symptom for many palliative care patients but is rarely identified. It's known to reduce quality of life and impact on palliation of physical symptom. These physical symptoms can be improved by an adequate treatment of depression. Many depressed cancer patients are not treated due to the difficulty in assessment. The Brief Edinburgh Depression Scale (BEDS) is widely used within the UK and also in other countries but its use is limited by the lack of translations. In this study, we report the translation and validation of the BEDS in French. METHOD: A group of experts translate the BEDS using back-to-back translation and the standard procedures of the EORTC. All the patients admitted to our Palliative Care Unit between November 2007 and April 2008 were eligible to take part in the study. The French BEDS was validated against the gold standard, a semi structured psychiatric interview (according to the SADS ou Schedule for Affective Disorders Scale). For this study full regional ethical approval was obtained. RESULTS: Forty-eight patients participated in the validation study. The prevalence of depression according to psychiatric interview was found to be 56.3% and the optimum cut-off of the French BEDS was 7, which yielded a sensitivity of 82.4% and a specificity of 68.4%. CONCLUSION: We believe that the French BEDS is a valid and sensitive tool for screening depression, and that it can be used within the palliative care population. Further work might be necessary to extend its use to the wider oncology population.