Depressive symptoms in advanced cancer. Part 2. Depression over time; the role of the palliative care professional

Objective: To survey changes in depressive symptoms over time in patients with advanced cancer using the Mood Evaluation Questionnaire (MEQ), and explore how effective Palliative Care Professionals (PCPs) are at assessing this. Method: Forty-five advanced cancer patients were followed monthly for up to six interviews (108 interviews in total). Selected clinical variables were recorded. Results: At first interview, 26 (58%) patients were depressed using MEQ, seven (16%) severely. Attrition rates were high, with 28, 13, nine, seven and six patients available for subsequent interviews. A > 12-point increase in MEQ over sequential interviews was associated with reduced survival (Hazard ratio 3.2, CI 1.2-8.4). PCPs recognized depressed mood, but underdiagnosed severe depression in 9% of patients (CI 3-16%, P = 0.002). A past history of depression was a strong indicator of current depressed mood on the MEQ. Conclusion: Change in depressive symptoms over time is related to mortality in this patient cohort, patients with marked deterioration in mood dying earlier. PCPs usually recognize patients' depression but underestimate the severity of depressed mood.