title: Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial.
abstract: BACKGROUND
  Brief tools are needed to screen oncology outpatients for depressive symptoms.
  
  
  METHODS
  Patients starting radiotherapy for the first diagnosis of any tumor completed distress screening tools, including the 9-item Patient Health Questionnaire (PHQ-9), the 2-item Patient Health Questionnaire (PHQ-2), the National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), and the Hopkins Symptom Checklist (HSCL) (25-item version). Patients exceeding validated cutoff scores and a systematic sample of patients whose screening was negative completed the Structured Clinical Interview for DSM-IV (SCID) mood disorder modules via telephone.
  
  
  RESULTS
  Four hundred sixty-three patients from 35 community-based radiation oncology sites and 2 academic radiation oncology sites were recruited. Sixty-six percent of the 455 eligible patients (n = 299) were women, and the eligible patients had breast (45%), gastrointestinal (11%), lung (10%), gynecologic (6%), or other cancers (27%). Seventy-five (16.5%) exceeded screening cutoffs for depressive symptoms. Forty-two of these patients completed the SCID. Another 37 patients whose screening was negative completed the SCID. Among the 79 patients completing the SCID, 8 (10.1%) met the criteria for major depression, 2 (2.5%) met the criteria for dysthymia, and 6 (7.6%) met the criteria for an adjustment disorder. The PHQ-2 demonstrated good psychometric properties for screening for mood disorders with a cutoff score of ≥3 (receiver operating characteristic area under the curve [AUC], 0.83) and was comparable to the PHQ-9 ( > 9; AUC = 0.85). The NCCN-DT did not detect depression (AUC = 0.59).
  
  
  CONCLUSIONS
  The PHQ-2 demonstrated good psychometric properties for screening for mood disorders, which were equivalent to the PHQ-9 and superior to the NCCN-DT. These findings support using the PHQ-2 to identify patients in need of further assessment for depression, which has a low prevalence but is a clinically significant comorbidity. These findings could inform the implementation of distress screening accreditation standards. Cancer 2017;123:485-493. © 2016 American Cancer Society.
authors.affiliation: Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Lynne I
authors.initials: LI
authors.lastname: Wagner
authors.affiliation: NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Pugh
authors.affiliation: Department of Radiation Oncology, Loyola University, Chicago, Illinois.
authors.forename: William
authors.initials: W
authors.lastname: Small
authors.affiliation: Hematology-Oncology Associates of Central New York (Community Clinical Oncology Program), East Syracuse, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Kirshner
authors.affiliation: Southeast Cancer Control Consortium (Community Clinical Oncology Program), Winston-Salem, North Carolina.
authors.forename: Kulbir
authors.initials: K
authors.lastname: Sidhu
authors.affiliation: Grand Rapids Clinical Oncology Program, Grand Rapids, Michigan.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Bury
authors.affiliation: Main Line Health (Community Clinical Oncology Program), Philadelphia, Pennsylvania.
authors.forename: Albert S
authors.initials: AS
authors.lastname: DeNittis
authors.affiliation: Hematology-Oncology Associates of Central New York (Community Clinical Oncology Program), East Syracuse, New York.
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Alpert
authors.affiliation: Northern Indiana Cancer Research Consortium (Community Clinical Oncology Program), South Bend, Indiana.
authors.forename: Binh
authors.initials: B
authors.lastname: Tran
authors.affiliation: North Shore University Hospital (Community Clinical Oncology Program), Manhasset, New York.
authors.forename: Beatrice F
authors.initials: BF
authors.lastname: Bloom
authors.affiliation: Mercy Hospital St. Louis, St. Louis, Missouri.
authors.forename: Julie
authors.initials: J
authors.lastname: Mai
authors.affiliation: St. Vincent Anderson Regional Hospital, Anderson, Indiana.
authors.forename: Alexander
authors.initials: A
authors.lastname: Yeh
authors.affiliation: Carle Cancer Center (Community Clinical Oncology Program), Urbana, Illinois.
authors.forename: Kalika
authors.initials: K
authors.lastname: Sarma
authors.affiliation: Columbus Community Clinical Oncology Program, Columbus, Ohio.
authors.forename: Mark
authors.initials: M
authors.lastname: Becker
authors.affiliation: NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.
authors.forename: Jennifer
authors.initials: J
authors.lastname: James
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
authors.forename: Deborah Watkins
authors.initials: DW
authors.lastname: Bruner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D011594:Psychometrics; D011878:Radiotherapy / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: depression; depression screening; distress; distress screening; mood disorders