title: Management of Depression in Patients With Cancer: A Clinical Practice Guideline.
abstract: This report updates the Cancer Care Ontario Program in Evidence-Based Care guideline for the management of depression in adult patients with cancer. This guideline covers pharmacologic, psychological, and collaborative care interventions, with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer.
  
  
  
  Recommendations were developed by synthesizing information from extant guidelines and reviews and searching for randomized controlled trials from the date of database inception (1964 for MEDLINE and 1974 for EMBASE) to January 2015. Quality assessment of guidelines and systematic reviews were conducted by using the Appraisal of Guidelines for Research and Evaluation II (AGREE II), Assessment of Multiple Systematic Reviews (AMSTAR), and Cochrane Risk of Bias tools. Final recommendations were developed through a standardized Program in Evidence-Based Care multidisciplinary expert and knowledge user review process.
  
  
  
  Two high-quality relevant clinical practice guidelines, eight pharmacologic trials, nine psychological trials, and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed. Eight specific recommendations were made to establish a standard of care for the management of depression in patients with cancer. The recommendations and practical management tools were reviewed as being well organized and helpful, although systemic barriers to implementation were identified.
  
  
  
  This updated guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and/or pharmacologic interventions, without evidence for the superiority of any specific treatment over another. New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression.
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada ccopgi@mcmaster.ca.
authors.forename: Madeline
authors.initials: M
authors.lastname: Li
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
authors.forename: Erin B
authors.initials: EB
authors.lastname: Kennedy
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
authors.forename: Nelson
authors.initials: N
authors.lastname: Byrne
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gérin-Lajoie
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Katz
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
authors.forename: Homa
authors.initials: H
authors.lastname: Keshavarz
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Sellick
authors.affiliation: Princess Margaret Cancer Centre, University Health Network; Cancer Care Ontario; and University of Toronto, Toronto; Cancer Care Ontario Program in Evidence-Based Care, McMaster University, Hamilton; Trillium Health Partners, Mississauga Halton-Central West Regional Cancer Program, Mississauga; Ottawa Hospital Cancer Centre, Ottawa; Stronach Regional Cancer Centre and Southlake Regional Health Centre, Newmarket; and Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.
authors.forename: Esther
authors.initials: E
authors.lastname: Green
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003863:Depression / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy / Q000628:therapy*; D009864:Ontario; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic
chemical_list: D000928:Antidepressive Agents