alex j mitchell consultant in psycho-oncology and hon snr university of leicester
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How many people with distress or depression receive psychosocial care in cancer settings? ………………An updated meta-analysis. Alex J Mitchell Consultant in Psycho-oncology and Hon SnR University of Leicester. - PowerPoint PPT PresentationTRANSCRIPT
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
[email protected] www.twitter.com/[email protected] 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