title: Management of depression for people with cancer (SMaRT oncology 1): a randomised trial.
abstract: BACKGROUND
  Major depressive disorder severely impairs the quality of life of patients with medical disorders such as cancer, but evidence to guide its management is scarce. We aimed to assess the efficacy and cost of a nurse-delivered complex intervention that was designed to treat major depressive disorder in patients who have cancer.
  
  
  METHODS
  We did a randomised trial in a regional cancer centre in Scotland, UK. 200 outpatients who had cancer with a prognosis of greater than 6 months and major depressive disorder (identified by screening) were eligible and agreed to take part. Their mean age was 56.6 (SD 11.9) years, and 141 (71%) were women. We randomly assigned 99 of these participants to usual care, and 101 to usual care plus the intervention, with minimisation for sex, age, diagnosis, and extent of disease. The intervention was delivered by a cancer nurse at the centre over an average of seven sessions. The primary outcome was the difference in mean score on the self-reported Symptom Checklist-20 depression scale (range 0 to 4) at 3 months after randomisation. Analysis was by intention to treat. This trial is registered as ISRCTN84767225.
  
  
  RESULTS
  Primary outcome data were missing for four patients. For 196 patients for whom we had data at 3 months, the adjusted difference in mean Symptom Checklist-20 depression score, between those who received the intervention and those who did not, was 0.34 (95% CI 0.13-0.55). This treatment effect was sustained at 6 and 12 months. The intervention also improved anxiety and fatigue but not pain or physical functioning. It cost an additional pound sterling 5278 (US$10 556) per quality-adjusted life-year gained.
  
  
  CONCLUSIONS
  The intervention-Depression Care for People with Cancer-offers a model for the management of major depressive disorder in patients with cancer and other medical disorders who are attending specialist medical services that is feasible, acceptable, and potentially cost effective.
authors.affiliation: University of Edinburgh Cancer Research Centre, Western General Hospital, Crewe Road, Edinburgh, UK.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Strong
authors.forename: Rachel
authors.initials: R
authors.lastname: Waters
authors.forename: Carina
authors.initials: C
authors.lastname: Hibberd
authors.forename: Gordon
authors.initials: G
authors.lastname: Murray
authors.forename: Lucy
authors.initials: L
authors.lastname: Wall
authors.forename: Jane
authors.initials: J
authors.lastname: Walker
authors.forename: Gillian
authors.initials: G
authors.lastname: McHugh
authors.forename: Andrew
authors.initials: A
authors.lastname: Walker
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D003376:Counseling; D003866:Depressive Disorder / Q000145:classification / Q000451:nursing / Q000628:therapy*; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification / Q000523:psychology* / Q000628:therapy; D009859:Oncology Nursing / Q000379:methods*; D011788:Quality of Life; D012606:Scotland; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents