Insufficient care, sometimes absent, and often unsuitable. In cancer services, patients suffering from depression who are poorly treated are left alone in the face of their distress.
Cancer and depression. These two very distinct diseases often coexist. However, it is common for depression to remain ignored in cancer patients, underlines a series of studies published in The Lancet, as well as its editions dedicated to psychiatry and oncology. However, it is not for lack of solutions adapted to their situation.
20% of services without shrink
First edifying observation: Depressive symptoms are more common in patients with tumors. Those who have developed lung cancer are the most affected (13%). It is the result of monitoring of 21,000 Scottish patients. And yet, out of 10 patients treated for cancer and suffering from depression, 7 do not receive psychiatric care.
In France, the lack of mental health professionals in oncology services is clearly the cause. According to a survey by the French Society of Psycho-Oncology (SFPO), 1 in 5 establishments does not employ a psychiatrist or psychologist in its oncology department. In a large number of cases (41%), a single professional is responsible for monitoring all patients. The difficulty in identifying depressed patients is also due to their particular situation, as explained by Dr. Sarah Dauchy, President of the SFPO.
Listen to Dr Sarah Dauchy, President of the SFPO: “ Depressed patients tend to ask for less care, talk less, think things will never get better, and not ask for help. “
A multidisciplinary approach
Another pitfall in the care of these patients: the approach adopted. In most cases, it remains traditional, that is to say, it dissociates treatment of cancer and depression. The optimal method, say researchers at the University of Oxford (United Kingdom), is to involve teams of caregivers. They are publishing the results of two trials that assess the impact of the targeted “Depression Care for People with Cancer” program. It includes a specially trained psychiatric team, which works in collaboration with the oncology unit. This multidisciplinary approach systematically includes antidepressant treatment and psychological therapy.
Confirmed successes
A first study, published in 2008, found that the DCPC approach reduces depressive symptoms in cancer patients. This new series of studies confirms this. “DCPC’s tremendous benefits for cancer and depression patients prove what we can achieve if we take as much care in treating depression as we do in cancer,” said Prof. Michael Sharpe of Oxford University.
The first search, conducted on 500 depressive and cancerous patients with a good survival prognosis, shows that DCPC is much more effective than dissociated treatment. At 6 months, 62% of patients in the “DCPC” group saw their depressive symptoms reduced by at least half, compared to 17% of patients in the “traditional” group. ”
Listen to Dr Sarah Dauchy : ” When we do not relegate the suffering to the shrink, we manage to improve the psychological suffering of the patient. This is fundamental for a pathology that occurs in one in seven cases. “
Develop oncology psychiatry
The second part of the research focused on 142 lung cancer patients with a poor survival prognosis. Again, the results are encouraging: DCPC patients suffer from less severe depression than others. As Dr Jane Walker of the University of Oxford explains, “Lung cancer patients often have a poor prognosis. If they are also suffering from depression, it can spoil the time they have left to live. This trial shows that depression can be effectively treated in patients with poor prognosis, such as lung cancer, and their lives can be improved. “
There remains a size limit: the application. As the SFPO survey reveals, a majority of psychologists in oncology units practice alone. When this is the case, they only work in conjunction with the other teams in one out of two cases. To improve the situation, it will therefore be necessary to employ more mental health professionals in these services. Because the results show it: when psychiatrists are not isolated, they partner with other caregivers in 86% of cases.
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