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Patients undergoing radiotherapy in busy community-based radiation oncology practices can be screened for depression effectively using a two-item questionnaire administered by clinical staff, according to results of a trial conducted by the Radiation Therapy Oncology Group (RTOG) Community Clinical Oncology Program (CCOP) and presented today at the plenary session of the American Society for Radiation Oncology (ASTRO) 55th Annual Meeting. “It is particularly exciting to observe that, across the three screening approaches we evaluated, a very simple and easy-to-administer two-item questionnaire proved to be effective for identifying patients who require further evaluation for depression,” says RTOG 0841 Co-principal Investigator William Small, M.D., FACRO, FACR, FASTRO, chairman of the Department of Radiation Oncology at Stritch School of Medicine Loyola University in Chicago, who presented the trial results.

Study participants enrolled in RTOG 0841 and about to undergo radiotherapy completed three depression screening questionnaires in the radiation oncology clinic: the Patient Health Questionnaire-9 Item (PHQ-9), which contains the Patient Health Questionnaire-2 Item (PHQ-2), The Hopkins Symptom Checklist (HSCL-25); and the single-item National Comprehensive Cancer Network® (NCCN) Distress Thermometer. Participants who screened positive for depression were contacted by a clinical psychologist who then administered the Structured Clinical Interview for DSM-IV Disorders (SCID) Mood Disorder modules via a telephone interview.
 
 “We used the SCID, a well-recognized gold standard for diagnosing  mood disorders including depression, to determine how accurately the screening questionnaires identified clinically depressed patients,” says RTOG 0841 Principal Investigator Lynne  Wagner, Ph.D., an associate professor in the Department of Medical Social Sciences at the Northwestern University Feinberg School of Medicine in Chicago. “Our data show that the PHQ-2 accurately identifies patients for whom further assessment is indicated.” We also established that the widely used NCCN Distress Thermometer, while effective at detecting anxiety, is not an adequate depression screening tool.” 

“Our data help to fill a research gap with regard to understanding the proportion of patients receiving radiotherapy who indicated the need for additional psychosocial assessment and in establishing that screening patients for depression in this setting was feasible,” says Wagner. According to Wagner “these results can be used by cancer programs to inform the development of effective distress screening programs, in light of upcoming accreditation requirements.”  She stresses the importance of asking patients how they are doing emotionally at every point along the continuum of their care, especially during times of treatment transition (e.g., from chemotherapy to radiotherapy, from radiotherapy to post-treatment survivorship) when they may experience a greater risk of elevated distress.

Small reports that all of the 455 eligible study participants enrolled in the trial at primarily community-based treatment facilities (35 of 37 sites) successfully completed 100 percent of the screening questionnaires “Approximately 16 percent of the patients exceeded the cut-off scores on our screening measures and required further evaluation,” says Small. “Upon administration of the SCID, we found that 3 percent of patients met the criteria for a mood disorder.”  Small notes that a significant point of emphasis in deploying the RTOG 0841 trial was to ensure that sites had services in place to respond to any emergent situations. “If you are going to ask questions about patients’ emotional well-being, you have to have a good understanding of what to do when people answer them,” says Small.

“There’s considerable evidence that depression is an important indicator for patients at risk for poorer outcomes and a symptom that significantly compromises quality of life. It is gratifying to have empirical evidence presented that establishes the PHQ-2 as an easily implemented, depression screening tool to help radiation oncology practices identify patients in need of further evaluation, so that, if necessary, they can be referred to appropriate community resources,” says Deborah W. Bruner, R.N., Ph.D., FAAN, Principal Investigator of the RTOG CCOP Research Base and associate director of outcomes at the Winship Cancer Institute of Emory University in Atlanta.

“Spotlighting the RTOG 0841 research results at an ASTRO plenary session provides a strong message that our patients’ psychosocial needs are truly an important component of providing good quality cancer care. I am very proud of the tremendous work RTOG investigators have done in this area and congratulate the RTOG 0841 investigators on this major accomplishment,” says Walter J. Curran Jr., M.D., RTOG Group Chairman and Executive Director of the Winship Cancer Institute.