© 2004 by Oxford University Press
© 2004 Oxford University Press
CORRESPONDENCE |
Re: National Institutes of Health State-of-the-Science Conference Statement: Symptom Management in Cancer: Pain, Depression, and Fatigue, July 15–17, 2002
Correspondence to: Jill M. Forcina, RN, BSN, OCN, University of North Carolina at Chapel Hill, School of Nursing, CB 7460, Carrington Hall, Chapel Hill, NC 27599-7460 (e-mail: forcina{at}email.unc.edu)
Having read the full 2002 report by the Agency for Health Care Research and Quality (1), I am bewildered by what seems to be conflicting information. In regard to the assessment instruments for depression, the authors of the special article (2) note that "the cutoff scores for clinically significant depression have been established." However, I have concluded from my literature review that each of these tools could benefit from further refinement. For example, the Hospital Anxiety and Depression Scale, which is the most commonly used screening tool in the cancer population, can result in false negatives and false positives for cancer patients (3–5). Other research has indicated that the Hospital Anxiety and Depression Scale has potential for use in oncology practice but that the threshold scores may need modification to increase its validity (6). I have found similar studies that examine some of the other common screening tools, such as the Rotterdam Symptom Checklist, the Self-Rating Depression Scale, and the Visual Analogue Scale. Although all of these tools have been examined in the oncology population, I am not yet convinced that their threshold scores have been established and supported by the research either.
In addition to the authors' notations on the assessment of depression in cancer patients, I am curious about which of the published studies examine the "alternative criteria for major depression in cancer patients [that] are available but yield similar findings to the standard approach of the Diagnostic and Statistical Manual, version IV" (2). I assume the authors are referring to the substitutions recommended by Endicott (7), but I am unable to locate any studies that actually implement these substitutions and evaluate the outcomes in a controlled environment.
I would appreciate it if the authors could share their literature sources, if possible.
REFERENCES
1 Carr D, Goudas L, Lawrence D, Pirl W, Lau J, DeVine D, et al. Management of cancer symptoms: pain, depression, and fatigue. Evidence Report/Technology Assessment Number 61. New England Medical Center EPC, Boston, MA. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2002. AHRQ Publ No. 02-E032. Available at: http://www.ahrq.gov/clinic/casyminv.htm. [Last accessed: May 28, 2004.]
2 Patrick DL, Ferketich SL, Frame PS, Harris JJ, Hendricks CB, Levin B, et al. National Institutes of Health State-of-the-Science Conference Statement: Symptom Management in Cancer: Pain, Depression, and Fatigue, July 15-17, 2002. J Natl Cancer Inst 2003;95: 1110–7.
3 Lloyd-Williams M. Screening for depression in palliative care patients: a review. Eur J Cancer Care (Engl) 2001;10:31–5.
4 Love AW, Kissane DW, Bloch S, Clarke D. Diagnostic efficiency of the Hospital Anxiety and Depression Scale in women with early stage breast cancer. Aust N Z J Psychiatry 2002;36:246–50.[Medline]
5 Hall A, A'Hern R, Fallowfield L. Are we using appropriate self-report questionnaires for detecting anxiety and depression in women with early breast cancer? Eur J Cancer 1999;35:79–85.[CrossRef][Web of Science][Medline]
6 Razavi D, Delvaux N, Farvacques C, Robaye E. Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry 1990;156:79–83.
7 Endicott J. Measurement of depression in patients with cancer. Cancer 1984;53(10 Suppl):2243–9.
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J Natl Cancer Inst 2004 96: 1110.
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