Richardson, Jarrett

Prevalence of treatable depression is as high as 25% among terminally ill patients. The incidence of antidepressant use was ascertained at the Mayo Hospice Program in Rochester, Minnesota, from June 1, 2007, to December 31, 2008. The 18-month cumulative probability to receive an antidepressant during hospice was estimated at 11.7%. Depression and selective serotonin reuptake inhibitors (SSRIs) were the most common clinical indication and class of antidepressant, respectively. Survival was the main predictor to receive an antidepressant with an odds ratio of 2.71 (95%CI: 1.60-4.60) for each additional day in hospice. Proper diagnostic tools for this population, education about the benefits of antidepressants in palliative care, and clear guidelines about antidepressant class and dosages are needed.

Purpose The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer. Patients and Methods Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27. Results Of the 103 participants, overall QOL at week 4 was maintained by the patients in the intervention (n = 49), whereas QOL at week 4 significantly decreased for patients in the control group (n = 54). This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group (P = .009). Intervention participants maintained their QOL, and controls gradually returned to baseline by the end of the 6-month follow-up period. Conclusion Although intervention participants maintained and actually improved their QOL during radiation therapy, control participants experienced a significant decrease in their QOL. Thus, a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment.