Screening for depression in cancer patients receiving radiotherapy: Feasibility and identification of effective tools in the NRG Oncology RTOG 0841 trial Journal Article


Authors: Wagner, L. I.; Pugh, S. L.; Small, W., Jr; Kirshner, J.; Sidhu, K.; Bury, M. J.; DeNittis, A. S.; Alpert, T. E.; Tran, B.; Bloom, B. F.; Mai, J.; Yeh, A.; Sarma, K.; Becker, M.; James, J.; Bruner, D. W.
Article 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. (c) 2016 American Cancer Society.
Keywords: Radiation Oncology; Depression; depression screening; distress; distress screening; mood disorders
Journal Title: Cancer
Volume: 123
Issue: 3
ISSN: 1097-0142; 0008-543X
Publisher: American Cancer Society  
Journal Place: United States
Date Published: 2017
Start Page: 485
End Page: 493
Language: eng
DOI/URL:
Notes: LR: 20170220; CI: (c) 2016; GR: U10 CA180868/CA/NCI NIH HHS/United States; GR: UG1 CA189867/CA/NCI NIH HHS/United States; GR: U10 CA037422/CA/NCI NIH HHS/United States; GR: U10 CA021661/CA/NCI NIH HHS/United States; GR: U10 CA180822/CA/NCI NIH HHS/United States; JID: 0374236; NIHMS763994; OTO: NOTNLM; PMCR: 2018/02/01; 2015/12/01 [received]; 2016/01/08 [revised]; 2016/01/12 [accepted]; ppublish
LUC Authors
  1. William Small
    122 Small