• Rodin G, Katz M, Lloyd N, Green E, Mackay JA, Wong R, Supportive Care Guidelines Group. The management of depression in cancer patients: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Oct 17. 39 p. (Evidence-based series; no. 13-6). [78 references]

There is an absence of clear evidence derived from randomized controlled trials in cancer patients on which to inform the conclusions; therefore, the following recommendations reflect the expert consensus of the guideline panel members (which comprises nurses, palliative care physicians, medical, surgical, and radiation oncologists, an anesthetist, radiation therapists, methodologists, administrators, two psychiatrists and one psychologist) informed by the evidence reviewed and feedback from Ontario health care providers.

• Treatment of pain and other reversible physical symptoms should be instituted prior to the initiation of specific antidepressant treatment.
• Antidepressant medications should be considered to treat moderate to severe major depression in cancer patients. Current evidence, however, does not support the relative superiority of one pharmacological modality of treatment over another nor the superiority of pharmacological versus psychosocial interventions. The choice of an antidepressant should be informed by the side effect profiles of medication, tolerability of treatment including the potential for interaction with other current medications, response to prior treatment, and patient preference.
• Cancer patients diagnosed with major depression may benefit from a combined modality approach that includes both psychosocial and pharmacological interventions. Psychosocial treatment approaches that may be of value include those that provide information and support and which address emotional, cognitive, and/or behavioural factors.

None provided

The recommendations are supported by randomized trials, a systematic review, and a comparative cohort study.

• Rodin G, Katz M, Lloyd N, Green E, Mackay JA, Wong R, Supportive Care Guidelines Group. The management of depression in cancer patients: a clinical practice guideline. Toronto (ON): Cancer Care Ontario (CCO); 2006 Oct 17. 39 p. (Evidence-based series; no. 13-6). [78 references]

Not applicable: The guideline was not adapted from another source.

2006 Oct

Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]

The Program in Evidence-based Care (PEBC) is a Province of Ontario initiative sponsored by Cancer Care Ontario and the Ontario Ministry of Health and Long-Term Care.

Cancer Care Ontario
Ontario Ministry of Health and Long-Term Care

Supportive Care Guidelines Group

Dr. Katz has acted as a consultant or received honoraria from Wyeth, a manufacturer of venlafaxine; Lundbeck, a manufacturer of escitalopram and citalopram; and Organon, a maker of mirtazapine. No other potential conflicts of interest were declared by the authors of this Evidence-Based Series report.

None available

None available

This summary was completed by ECRI on March 27, 2008.