ONS Connect - February 2008 - (Page 23) Figure 1. Interventions for Depression in People With Cancer Recommended for Practice Psychoeducational or Psychosocial • Cognitive behavioral therapy • Patient education and informa tion • Counseling or psychotherapy • Behavioral therapy • Social support Pharmacologic • Antidepressants – Selective serotonin reuptake inhibitors – Tricyclic antidepressants – Serotoninnorepinephrine reuptake inhibitors – Others (mirtazapine [Re meron®, Organon USA], bupropion [Wellbutrin®, GlaxoSmithKline], trazodone [Desyrel®, BristolMyers Squibb], mianserin [Tolvon®, Organon]) Likely to Be Effective Methylphenidate (Ritalin®, Novartis) Relaxation therapy (complementary and alternative medicine) Effectiveness Not Established Complementary and alternative medicine • Massage therapy • Hypnotherapy Effectiveness Unlikely No evidence for any intervention Not Recommended for Practice No evidence for any intervention Note. Based on information from Fulcher et al., 2008. • Beliefs by patients and providers that depression is an expected correlate of cancer diagnosis • The reluctance of patients to share psychological concerns • The reticence of some professionals to assess patients for depressive symp toms in busy oncology settings. In 2006, the ONS Putting Evidence Into Practice ® (PEP) Depression In tervention Project Team reviewed, cri tiqued, and summarized the research evidence for nursing interventions relat ed to depression in people with cancer. Their work is reported in the February 2008 issue of Clinical Journal of Oncology Nursing (Fulcher, Badger, Gunter, Marrs, & Reese, 2008). The PEP team’s review of evidence based interventions for depression in patients with cancer is summarized in Figure 1. The team found that evidence at the highest level supports the benefit of psychoeducational or psychosocial interventions in the management of de pressive symptoms during and following cancer treatment. Psychoeducational or psychosocial interventions include cog nitive behavioral therapy, patient edu cation and information, counseling or psychotherapy, behavioral therapy, and supportive interventions. The therapies and interventions may take many forms, and they may be combined with pharma cologic interventions. Although relatively few randomized clinical trials have examined the effec tiveness of antidepressants in patients with cancer, the team concluded that the evidence does support the use of tri cyclic antidepressants, selective sero tonin reuptake inhibitors, mianserin (not available in the United States), and oth ers. See Figure 1 and the PEP card for more details (available at www.ons.org/ outcomes/volume2/depression.shtml). Experts recommend that, during and following cancer treatment, healthcare providers (a) assess patients for depres sion and depressive symptoms at every encounter (see screening tools for de pression at www.ons.org/outcomes/mea sures/summaries.shtml#dep); (b) assess patients’ and families’ understanding of depression and its role in cancer recov ery, as well as the meaning of depres sion to patients and their families; and (c) provide education and information to patients and families about depression and its management. Although no evidence supports the combination of antidepressant medica tion and psychoeducational or psychoso cial therapy in patients with cancer and depression, clinical practice guidelines for the treatment of depression do rec ommend combined therapy for severe and chronic depression. Oncology nurses can advocate for pa tients and their families to improve rec ognition and treatment of depressive symptoms or depression and collaborate with mental health professionals to en sure comprehensive care. The ONS PEP card on depression is available in volume 2 of the ONS PEP cards, which also contains cards on caregiver burden and strain, constipa tion, mucositis, dyspnea, and peripheral neuropathy. To order the pocket cards, visit http://esource.ons.org/Publications or email customer.service@ons.org. ✱ Fulcher, C.D., Badger, T., Gunter, A.K., Marrs, J.A., & Reese, J.M. (2008). Putting evidence into practice: Interventions for depression. Clinical Journal of Oncology Nursing, 12(1), 131–140. National Cancer Institute. (2007). Depression: Overview. Retrieved December 10, 2007, from http://www.cancer.gov/cancertopics/pdq/sup portivecare/depression/Patient/page2 National Comprehensive Cancer Network. (2007). NCCN Clinical Practice Guidelines in Oncology: Distress management. V.1.2007. Retrieved December 5, 2007, from http://www.nccn.org/ professionals/physician_gls/PDF/distress.pdf February 2008 ONS CONNECT 23 http://www.ons.org/outcomes/measures/summaries.shtml#dep http://www.ons.org/outcomes/measures/summaries.shtml#dep http://esource.ons.org/Publications http://www.cancer.gov/cancertopics/pdq/supportivecare/depression/patient/page2 http://www.cancer.gov/cancertopics/pdq/supportivecare/depression/patient/page2 http://www.ons.org/outcomes/volume2/depression.shtml http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf http://www.ons.org/outcomes/volume2/depression.shtml http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf
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