Developing tailored strategies that encourage staff at oncology clinics to routinely screen patients with breast cancer for depression can help increase the number of patients connected with behavioral health services, suggests a report published today in JAMA.
Depression is known to be associated with worse outcomes in cancer patients, including decreased social and physical functioning and poor quality of life. The American College of Surgeons Commission on Cancer recommends that health professionals screen cancer patients for distress; however, patients with breast cancer are often underdiagnosed and undertreated for depression and depressive symptoms, wrote Erin E. Hahn, Ph.D., M.P.H., of Kaiser Permanente Southern California and colleagues.
Hahn and colleagues wanted to know whether a depression screening program tailored to individual oncology clinics might increase the proportion of patients receiving referrals to behavioral health services compared with an education-only strategy. They randomized six medical centers within Kaiser Permanente Southern California that were treating patients diagnosed with a new primary breast cancer to one of two interventions: three centers received a tailored intervention; the other three received general education about the program. All centers were encouraged to screen newly diagnosed patients with the nine-item Patient Health Questionnaire (PHQ-9) and, as indicated based on PHQ-9 scores, refer patients for additional behavioral health services.
The clinical teams at tailored intervention sites were educated about the PHQ-9 and the scoring-referral algorithm, engaged in regular check-ins with a nurse researcher, and received tailored audit and feedback reports of progress compared with those of the other intervention sites throughout the study. The teams at the education-only sites were provided with general information about the screening program, including the PHQ-9 questionnaire and scoring-referral algorithm.
The trial included 1,436 patients diagnosed with new primary breast cancer who had a consultation with medical oncology between October 1, 2017, through September 30, 2018; these patients were followed up to May 31, 2019, insurance disenrollment, or death. Regardless of PHQ-9 screening, a significantly greater number of patients in the tailored intervention group received a referral for any behavioral health service compared with patients treated at the education-only clinics during the study period: 135 patients (18%) vs. 74 (11%), the authors reported.
“Given the high burden of depression in patients with breast cancer, effective screening and referral programs are needed. In the current era of heightened health-related concerns due to SARS-CoV-2, which may disproportionately affect patients with cancer and survivors, systematic depression screening and referral for patients with cancer may be even more important,” Hahn and colleagues concluded.
For related information, see the Psychiatric Services article “Factors Influencing Receipt of Mental Health Services Among Medicaid Beneficiaries With Breast Cancer.”
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