The treatment gap of depression in persons with cancer.
The epidemiology of depression showed that the rates are high. For example, the World Mental Health Survey, an epidemiologic community study conducted in 28 countries, found a life-time prevalence rate that ranged from 3.3 % in Nigeria to 21.4% % in the US. With regard to persons with cancer, 12.5% of a sample of over 17,000 respondents over the age of 50 of a US survey of community-dwelling adults found that people that reported they had cancer had higher risk of fatigue (OR =1.5 95% CI 1.3-1.6); depression (OR=1.2, 95% CI 1.1-1.4) and pain (OR =1.2, 95% CI 1.03-1.3.).The rate of depression seems to be differently associated with cancer site. For example: It is higher in pancreatic cancer (33%-50%) and lung (11%-44%), and it is lower in lymphoma (8%-19%) and colon (13% and 25%). For breast cancer--likely the most studied cancer site- the prevalence ranges from 1.5% to 46%. Ciaramelli and Poli (2001) found that depressed persons had more pain and metastasis than the non-depressed but no more lifetime depression that the non-depressed. In terminally patients, studies have found that the higher the level of disability the higher the rates of depression. Interestingly, while almost all studies of depression in the community found higher rates in women than in men--this is far from the rule among persons with cancer. Despite the marked burden and the existence of effective treatment, a very large proportion of the persons with depression remain untreated. The causes to be imputed for the treatment gap are of different nature. Some of these causes are related to the suffering person, to the social context and to the health system. Often, the treating physicians fail to identify depression and to treat it properly. For example, in one evaluation of 456 outpatients with solid tumors a minority (14%) of the depressed were identified as such. Why is it important to assess depression in persons with cancer? Untreated depression both enhances the risks to life and it lowers the quality of life. It may be associated to a reduced chance of survival in women with early stage breast cancer. One possible reason is limited adherence to the treatment plan. Timely identification and well prescribed and conducted tre.
Levav
Itzhak
I
Ministry of Health, Jerusalem, Israel. Itzhak.Levav@moh.health.gov.il
D003863:Depression / Q000453:epidemiology; D003866:Depressive Disorder; D005221:Fatigue; D006801:Humans; D015995:Prevalence; D011788:Quality of Life