Two-question screening test may reveal depression in cancer patients

Cancer patients can be accurately screened for major depression with a simple two-question survey, according to a study presented Sept. 23 at the American Society for Radiation Oncology's 55th Annual Meeting.

The two-question screening test proved to be as accurate as a longer nine-question screening test.

The study was presented at plenary session by William Small, Jr., MD, FASTRO, chair of the Department of Radiation Oncology of Loyola University Medical Center.

"We found that a two-question survey can effectively screen for depression," Small said. "We hope this will prompt more centers to screen for depression, and to refer patients for treatment when necessary."

The two-question survey asks whether, over the last two weeks, a patient has experienced:

• Little interest or pleasure in doing things
• Feeling down, depressed or hopeless

For each question, the patient can answer not at all (worth zero points); several days (1 point); more than half the days (two points); or nearly every day (3 points). A patient who scores a total of three or more points on both questions is considered to be at risk for being depressed.

The study included 455 cancer patients receiving radiation therapy at 37 centers in the United States. Patients were surveyed before or within two weeks of receiving their first radiation treatment. Sixteen percent screened positive for depression.

For comparison purposes, patients who screened positive were administered an in-depth telephone interview known as SCID, which is considered the gold standard for diagnosing depression. A random sample of patients who screened negative for depression also underwent the SCID interview. (SCID stands for Structured Clinical Interview for DSM IV Disorders.)

The two-question survey consists of the first two questions of the nine-question Patient Health Questionnaire. The study found that the abbreviated two-question survey was just as accurate as the full nine-question survey. In statistical terms, both surveys had an "area under the curve" of 0.83. (A 100 percent accurate test would have an area under the curve of 1.0.)

The two-question screening test was more accurate than two other screening tests researchers administered. These less-accurate screening tests are the Hopkins Symptom Checklist (0.79 area under the curve) and the National Comprehensive Cancer Network Distress Thermometer (0.60 area under the curve).

The study found that 78 percent of centers routinely screen patients for depression at the radiation therapy facility, with 51 percent screening at the initial visit. Mental health services were available at 68 percent of radiation therapy facilities. However, 67 percent of sites offered only social workers; 17 percent offered psychologists and 22 percent offered psychiatrists.

"We think the results of this large, nationwide trial will have a major impact on how cancer patients are screened for depression," Small said.