How many people with distress or depression receive psychosocial care in cancer settings? ………………An updated meta-analysis

How many people with distress or depression receive psychosocial care in cancer settings? ………………An updated meta-analysis

Alex J MitchellConsultant in Psycho-oncology and Hon SnR

University of Leicester

ajm80@le.ac.uk www.twitter.com/_alexjmitchellajm80@le.ac.uk www.twitter.com/_alexjmitchell

Daily Mail

Screening

Symptoms

Help-seeking

Diagnosis

Treatment

Aftercare

ContextContext

Millions Living with Cancers (2010 SEER)

http://seer.cancer.gov/faststats/

3

4.6

6.6

9.6

13

0

2

4

6

8

10

12

14

:1970 :1980 :1990 :2000 :2010

Prevalence of depression in Oncology settings

70 studies involving 10,071 individuals;14 countries.16.3% (95% CI = 13.9% to 19.5%)

Mj 15% Mn 19% Adj 20% Anx 10% Dysthymia 3%

Proportion meta-analysis plot [random effects]

0.0 0.3 0.6 0.9

combined 0.1730 (0.1375, 0.2116)

Colon et al (1991) 0.0100 (0.0003, 0.0545)

Massie and Holland (1987) 0.0147 (0.0063, 0.0287)

Hardman et al (1989) 0.0317 (0.0087, 0.0793)

Derogatis et al (1983) 0.0372 (0.0162, 0.0720)

Lansky et al (1985) 0.0455 (0.0291, 0.0676)

Mehnert et al (2007) 0.0472 (0.0175, 0.1000)

Katz et al (2004) 0.0500 (0.0104, 0.1392)

Singer et al (2008) 0.0519 (0.0300, 0.0830)

Sneeuw et al (1994) 0.0540 (0.0367, 0.0761)

Pasacreta et al (1997) 0.0633 (0.0209, 0.1416)

Lee et al (1992) 0.0660 (0.0356, 0.1102)

Reuter and Hart (2001) 0.0761 (0.0422, 0.1244)

Grassi et al (2009) 0.0826 (0.0385, 0.1510)

Grassi et al (1993) 0.0828 (0.0448, 0.1374)

Walker et al (2007) 0.0831 (0.0568, 0.1165)

Kawase et al (2006) 0.0851 (0.0553, 0.1240)

Coyne et al (2004) 0.0885 (0.0433, 0.1567)

Alexander et al (2010) 0.0900 (0.0542, 0.1385)

Love et al (2002) 0.0957 (0.0650, 0.1346)

Ozalp et al (2008) 0.0971 (0.0576, 0.1510)

Morasso et al (2001) 0.0985 (0.0535, 0.1625)

Costantini et al (1999) 0.0985 (0.0535, 0.1625)

Silberfarb et al (1980) 0.1027 (0.0587, 0.1638)

Desai et al (1999) [early] 0.1111 (0.0371, 0.2405)

Morasso et al (1996) 0.1121 (0.0593, 0.1877)

Prieto et al (2002) 0.1227 (0.0825, 0.1735)

Ibbotson et al (1994) 0.1242 (0.0776, 0.1853)

Payne et al (1999) 0.1290 (0.0363, 0.2983)

Kugaya et al (1998) 0.1328 (0.0793, 0.2041)

Alexander et al (1993) 0.1333 (0.0594, 0.2459)

Gandubert et al (2009) 0.1597 (0.1040, 0.2300)

Razavi et al (1990) 0.1667 (0.1189, 0.2241)

Akizuki et al (2005) 0.1797 (0.1376, 0.2283)

Leopold et al (1998) 0.1887 (0.0944, 0.3197)

Devlen et al (1987) 0.1889 (0.1141, 0.2851)

Berard et al (1998) 0.1900 (0.1184, 0.2807)

Joffe et al (1986) 0.1905 (0.0545, 0.4191)

Berard et al (1998) 0.2100 (0.1349, 0.3029)

Maunsell et al (1992) 0.2146 (0.1605, 0.2772)

Grandi et al (1987) 0.2222 (0.0641, 0.4764)

Evans et al (1986) 0.2289 (0.1438, 0.3342)

Spiegel et al (1984) 0.2292 (0.1495, 0.3261)

Golden et al (1991) 0.2308 (0.1353, 0.3519)

Fallowfield et al (1990) 0.2565 (0.2054, 0.3131)

Hosaka and Aoki (1996) 0.2800 (0.1623, 0.4249)

Kathol et al (1990) 0.2961 (0.2248, 0.3754)

Green et al (1998) 0.3125 (0.2417, 0.3904)

Jenkins et al (1991) 0.3182 (0.1386, 0.5487)

Burgess et al (2005) 0.3317 (0.2672, 0.4012)

Hall et al (1999) 0.3722 (0.3139, 0.4333)

Morton et al (1984) 0.3958 (0.2577, 0.5473)

Baile et al (1992) 0.4000 (0.2570, 0.5567)

Passik et al (2001) 0.4167 (0.2907, 0.5512)

Bukberg et al (1984) 0.4194 (0.2951, 0.5515)

Massie et al (1979) 0.4850 (0.4303, 0.5401)

Ciaramella and Poli (2001) 0.4900 (0.3886, 0.5920)

Levine et al (1978) 0.5600 (0.4572, 0.6592)

Plumb & Holland (1981) 0.7750 (0.6679, 0.8609)

proportion (95% confidence interval)

“Most Pressing Issue” Leicester N=540

Rates of medical care?Rates of medical care?Baseline treatment and diagnosis rates

0

2

4

6

8

10

12

14

No mentaldisorder

Substanceabuse disorder

Other mentaldisorder

Mood disorder Any mentaldisorder

Psychoticdisorder

Dementia

Chances of No Treatment for Chances of No Treatment for Colorectal Ca Colorectal Ca (2011)(2011)

Baillargeon J, et al Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer. J Am Geriatr Soc. 2011 Jul;59(7):1268-73.

Baillargeon J, et al Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer. J Am Geriatr Soc. 2011 Jul;59(7):1268-73.

Chances of No Diagnosis for Colorectal Chances of No Diagnosis for Colorectal Ca Ca (2011)(2011)

0

1

2

3

4

5

6

7

8

9

10

No MentalDisorder (n

559,971)

Substance UseDisorder (n

53,443)

Other MentalDisorder (n

59,322)

Mood Disorder(n=8261)

Any MentalDisorder (n

520,699)

PsychoticDisorder (n

53,576)

Dementia (n57,267)

Dx Mental Health?Dx Mental Health?Are mental health diagnosed?

Comment: Slide illustrates diagnostic accuracy according to score on DT

11.815.4

30.4 28.9

41.9 42.9 40.7

57.1

82.4

66.771.4

15.8

25.0

26.124.4

19.4 19.0

33.3

21.4

11.8

22.2 14.3

72.4

59.6

43.546.7

38.7 38.1

25.921.4

5.911.1

14.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Zero One Two Three Four Five Six Seven Eight Nine Ten

Judgement = Non-distressed

Judgement = Unclear

Judgement = Distressed

Rx Mental Health?Rx Mental Health?Are mental health treated?

% Receiving Any treatment for Mental Health% Receiving Any treatment for Mental Health

7.2

34.6

5.7 6.3 6.4

11.7

19.1

14

8.9

3.9 3.2

5.7

32.7

5 5

7.7

11

16.1

6.5 6.2

2.3 1.8

0

5

10

15

20

25

30

35

40

Cancer n=4878

No Cancer n=90,737

Maria Hewitt, Julia H. Rowland Mental Health Service Use Among Adult Cancer Survivors: Analyses of the National Health Interview Survey Journal of Clinical Oncology, Vol 20, Issue 23 (December), 2002: 4581-4590

12mo Service Use 12mo Service Use (NIH, 2002)(NIH, 2002)

Two explanations=>

Receipt of Care

Receipt of Any Help

Receipt of Individual Support

Receipt of Information

Receipt of Group

Clinician Intervention (n=540)Clinician Intervention (n=540)

Diagnosis Yes Diagnosis No

Distress 59% helped 20% helped

Anxiety 33% helped 17.5% helped

Depression 39% helped 22% helped

Anger 30% helped 24% helped

Any of above 46% helped 20% helped

Updated meta-analysisUpdated meta-analysis

Want Help

Offered help

Received care

Distress

Proportion meta-analysis plot [random effects]

0.0 0.2 0.4 0.6 0.8

combined 0.43 (0.37, 0.49)

Baker-Glenn et al (2010) [distressed] 0.27 (0.20, 0.35)

Clover et al (2010) [Distressed] 0.29 (0.24, 0.35)

Morasso et al (2010) [Distressed] 0.31 (0.16, 0.50)

Ryan et al (2011) [Depressed] 0.32 (0.22, 0.43)

Graves et al (2007) [Distressed] 0.33 (0.27, 0.40)

Tuinman et al (2008) [Distressed] 0.43 (0.34, 0.53)

Söllner et al (2004) [Distress] 0.43 (0.33, 0.54)

Carlson et al (2010) [Distressed] 0.46 (0.41, 0.51)

Luutonen et al (2011) [Depressed] 0.47 (0.36, 0.58)

Sharpe et al (2004) [Depressed] 0.49 (0.41, 0.58)

Mitchell et al (2012) [Distress or Depressed] 0.56 (0.48, 0.64)

van Scheppingen et al (2011) [Distressed] 0.57 (0.44, 0.70)

Shim et al (2008) [Distressed] 0.66 (0.52, 0.77)

proportion (95% confidence interval)

PATIENTS……….. Want Help? (n=1844)

Proportion meta-analysis plot [random effects]

0.0 0.2 0.4 0.6 0.8 1.0

combined 0.40 (0.31, 0.50)

van Scheppingen et al (2011) [Referral] 0.14 (0.07, 0.25)

Mitchell et al (2012) [Referral] 0.19 (0.14, 0.25)

Verdonck-de Leeuw et al (2009) [Referral] 0.21 (0.05, 0.51)

Shimizu et al (2009) [Referral] 0.25 (0.18, 0.33)

Carlson et al (2010) [Referral] 0.30 (0.25, 0.35)

Keller et al (2004) [Referral] 0.34 (0.23, 0.46)

Bogaarts et al (2011) [Referral] 0.38 (0.27, 0.49)

Ellis et al (2009) [Referral] 0.42 (0.31, 0.54)

Kadan-Lottick et al (2005) 0.22 (0.17, 0.27)

Siedentopf et al (2009) 0.23 (0.19, 0.28)

van Scheppingen et al (2011) [help or referral] 0.32 (0.21, 0.45)

Bramsen et al (2008) 0.45 (0.35, 0.55)

Plass and Koch (2001) 0.47 (0.38, 0.56)

Shimizu et al (2005) 0.50 (0.41, 0.58)

Fritsche et al (2004) 0.51 (0.40, 0.61)

Mitchell et al (2012) [help or referral] 0.52 (0.46, 0.59)

Morasso et al (2010) 0.82 (0.66, 0.92)

Söllner et al (2004) 0.97 (0.91, 0.99)

proportion (95% confidence interval)

CLINICIANS. Who Offers Psychosocial Help? (n=2557)

How Many Patients Receive Psychosocial Help?

Proportion meta-analysis plot [random effects]

0.0 0.2 0.4 0.6 0.8 1.0

combined 0.35 (0.25, 0.46)

McDowell et al (2010) 0.14 (0.11, 0.18)

Sharpe et al (2004) 0.15 (0.10, 0.22)

Morasso et al (2010) 0.16 (0.05, 0.33)

Merckaert et al (2009) 0.21 (0.17, 0.25)

Shimizu et al (2009) 0.25 (0.18, 0.33)

Shimizu et al (2005) 0.28 (0.18, 0.41)

Söllner et al (2004) 0.35 (0.26, 0.45)

Bogaarts et al (2011) 0.38 (0.27, 0.49)

Fritsche et al (2004) 0.43 (0.28, 0.59)

Siedentopf et al (2009) 0.46 (0.35, 0.58)

Plass and Koch (2001) 0.60 (0.46, 0.72)

Kadan-Lottick et al (2005) 0.89 (0.77, 0.96)

proportion (95% confidence interval)

What Help is wantedWhat Help is wanted

37.6%

37.1%

36.5%

35.0%

34.9%

33.9%

32.9%

30.8%

30.7%

29.7%

29.6%

29.2%

27.5%

27.1%

25.5%

25.3%

24.8%

24.2%

24.0%

23.4%

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

Worry about the future

Supplements while on treatment

Sleeping

Finances

Side-effects of treatments

Understanding my treatment options

Fatigue

Pain

Feeling down or depressed

Managing my emotions

Talking with healthcare team

Feeling anxious or fearful

Insurance

Finding community resources

Feeling irritable or angry

Needing help coordinating my medicalcare

Losing control

Finding reliable head&neck information

Questions and fear about end of life

Bowel movement constipation

“Desire for Help” City of Hope n=4000

Inequalities in care?Inequalities in care?Are mental health concerns disproportionately ignored?

Psychooncology. 2011 Nov;20(11):1221-7. doi: 10.1002/pon.1849. Epub 2010 Sep 27.

1660 Cancer Patients in Florida 1660 Cancer Patients in Florida (Jacobsen, 2010)(Jacobsen, 2010)

86

12

38

73

47

50

74

57

14

26

34

47

84

95

8482

90

84

97

55

88 88

93

88

0

10

20

30

40

50

60

70

80

90

100

A B C D E F G H I J K Mean

Emotional Wellbeing Assessed

Pain Assessed

Where Next??Where Next??Addressing the gap