(ChemotherapyAdvisor) – A scarcity of clinical data leaves it unclear how best to address diagnosed depression among patients with lung cancer, but the available randomized, controlled trial data suggest that early initiation of palliative care and other “enhanced care approaches” might more effectively reduce depressive symptoms than standard medical care alone, concludes a new systematic review published in Lung Cancer.

“Better evidence from well-conducted randomized trials is urgently required to guide the treatment of depression in patients with lung cancer,” the authors reported after conducting an extensive search and review of the available research literature.

“Whilst it may be reasonable to treat depression in individuals with lung cancer with standard (depression) treatments until more specific evidence is available, clinicians should be aware that the effectiveness and potential adverse effects of these treatments remain unknown in this patient group,” reported lead author Jane Walker, MD, of the Psychological Medicine Research, Department of Psychiatry at Oxford University in England.

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Lung cancer patients tend to be older adults with multiple comorbidities. 

“As well as suffering severe physical deterioration they are aware of their poor prognosis,” the authors wrote. “It is therefore unsurprising that people with lung cancer have a high rate of depression.”

Despite the pressing need for evidence-based interventions, however, the authors found no completed randomized clinical trials specifically assessing treatment of clinical depression among patients with lung cancer. (A total of three such trials are under way, but none has yet been completed, the authors noted.)

However, the authors did identify six studies assessing quality-of-life interventions for patients with lung cancer in general – patients who were not selected for a diagnosis of clinical depression, but among whom depression was assessed and reported.

Early palliative care initiated soon after diagnosis of metastatic disease among patients with non-small cell lung cancer (NSCLC) results in lower rates of depression than standard care alone, according to one of the reviewed studies. Another study included in the review found that nursing interventions involving 1-on-1 assessment of symptoms, advice and support, and symptom-management training moderated worsening depression among patients with lung cancer who experienced breathlessness. Supportive psychotherapy interventions similarly reduce the rate of depression at 1 month, compared to rates among patients receiving anticancer therapies alone.