ReCAP: Would Women With Breast Cancer Prefer to Receive an Antidepressant for Anxiety or Depression From Their Oncologist? [CARE DELIVERY]

QUESTIONS ASKED:

Preferences of patients with breast cancer for provider-specific pharmacologic management of anxiety and depression are unknown. Use of patient-guided treatment preferences for the treatment of depression and anxiety are known to improve adherence and treatment outcomes in primary care settings, but these preferences are not known in women with breast cancer. This may be especially true shortly after the patient receives a diagnosis of cancer and is most psychologically symptomatic, yet committed to following through with her oncologic care. Do breast cancer patients have preferences regarding having their anxiety and depression assessed and treated by their oncologists versus being cared for by a psychiatrist or mental health provider?

SUMMARY ANSWER:

The majority of patients accepted antidepressant prescribing by their oncologist; only a minority preferred treatment by a mental health professional. These findings are consistent with previous data from medically ill patients that demonstrated a preference for medical providers to address and treat their depression or anxiety. Twenty percent of participants would not want any treatment. Patients who met depression criteria were less likely to prefer a mental health referral. Patients who were already taking an antidepressant or demonstrated higher levels of chronic stress were more likely to prefer a mental health referral.

METHODS:

Patients with breast cancer (stages 0-IV) were asked two questions: (1) "Would you be willing to have your oncologist treat your depression or anxiety with an antidepressant medication if you were to become depressed or anxious at any point during your treatment?" and (2) "Would you prefer to be treated by a psychiatrist or mental health professional for problems with either anxiety or depression?" In addition, the Distress Thermometer and Problem List, Hospital Anxiety and Depression Scale, Risky Families Questionnaire, and demographic information were assessed.

BIAS, CONFOUNDING FACTORS, DRAWBACKS:

This was a survey of only women who were asked to self-report hypothetical preferences. Although minimal differences were noted for the 16.8% of participants who were already taking an antidepressant medication, it is not clear how they might have interpreted the questions in a more realistic setting.

REAL-LIFE IMPLICATIONS:

These findings suggest a benefit for promoting education of oncologists to assess psychological symptoms and manage anxiety and depression as a routine part of an outpatient visit. It highlights a fertile opportunity for oncologists to integrate mental health treatment for their patients by beginning pharmacologic treatment, discussing their anxiety or depressive symptoms, and initiating or comanaging pharmacologic treatment of anxiety or depression. Early recognition and management of distress, anxiety, and depression would limit the delay in obtaining appropriate treatment, especially during the first year after a cancer diagnosis when patients are most symptomatic and have many difficult treatment decisions to make. The oncologist's use of antidepressant medications to treat anxiety and depression may benefit patients most by following guidelines. A collaborative care model offers one potential solution that could establish ownership, expand resources, disseminate knowledge, and provide a system of integration for mental health and oncology providers.

Table 1.

Cohort Characteristics and Preference for Oncologist Versus Mental Health Care Provider

Preference for Oncologist (n = 111)Preference for Psychiatrist/Mental Health Provider (n = 118)CharacteristicYes (n = 67; 60.4%)No (n = 44; 39.6%)Yes (n = 31; 26.3%)No (n = 44; 37.3%)Does Not Matter (n = 43; 6.4%)No.%No.%²pNo.%No.%No.%²pRace/ ethnicity Black or African American1218.201328.301.99.58412.91023.31024.410.15.12 White3756.102145.7022711848.92151.2 Latino1015.20817.80412.91125.64.09.8 Other710.6048.7013.249.3614.6Married3553.002143.800.96.331238.722502559.53.10.21Working3672.002363.900.64.422275.921751961.351.94.38Lumpectomy2437.552554.303.08.081346.41841.91947.50.30.86Mastectomy3654.502043.501.33.251344.82455.81946.31.10.58Chemotherapy3858.502756.300.06.812064.52556.82356.10.61.74Receiving anti-hormones3961.902043.503.64.061758.61945.22357.51.71.43Taking antidepressant1218.20918.800.01.941135.5613.6511.97.73.02*Distress Screen (DT&PL ≥4) n = 44 (55.1%)3054.502055.600.01.931659.32362.21445.22.16.34Distress Screen (DT&PL ≥7) n = 17 (17.2%)916.40616.700.00.9727.4924.3619.43.11.21Anxiety Screen (HADS-A ≥ 8), n = 46 (36.8%)2538.501634.000.23.631343.31432.61740.50.01.61Depression Screen (HADS-D ≥ 8), n = 25
(20.8%)1320.00817.000.16.69413.3818.61023.81.25.53MeanSDMeanSDTpMeanSDMeanSDMeanSDFpAge, years55.013.8956.213.080.47.6453.614.757.812.154.213.91.10.34Distress (DT&PL, range 0-10)3.92.333.81.95-0.10.924.22.04.33.03.42.51.15.32Anxiety (HADS-A, range 0-21)6.14.445.83.51-0.38.716.73.85.64.06.44.40.68.51Depression (HADS-D, range 0-21)3.53.914.43.321.23.223.73.73.93.74.13.90.12.89Chronic Stress (RFQ, range 13-65)23.611.8123.67.640.03.9826.8*9.120.5*8.224.012.03.60.03*

Abbreviations: DT&PL, Distress Thermometer and Problem List; HADS-A, Hospital Anxiety and Depression Scale-Anxiety; HADS-D Hospital Anxiety and Depression Scale-Depression; RFQ, Risky Families Questionnaire; SD, standard deviation.

*

p < .05.

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