ONCOLOGISTS RECOGNITION OF DEPRESSION IN THEIR PATIENTS WITH CANCER

Purpose: This study was performed as part of a large depression screen ing project in cancer patients to determine the degree of physician re cognition of levels of depressive symptoms in cancer patients and to d escribe patient characteristics that influence the accuracy of physici an perception of depressive symptoms. Methods: Twenty-five ambulatory oncology clinics affiliated with Community Cancer Care, Inc of Indiana enrolled and surveyed 1,109 subjects treated by 12 oncologists. Subje cts completed the Zung Self-Rating Depression Scale (ZSDS) and physici ans were asked to rate their patients' level of depressive symptoms, a nxiety,and pain using numerical rating scales. Subjects' sex, age, pri mary tumor type, medications, primary caregiver, and disease stage at diagnosis were also recorded. Results: Physician ratings of depression were significantly associated with their patients' levels of endorsem ent of depressive symptoms on the ZSDS. However, agreement between phy sicians and patients is most frequently clustered when patients report little or no depressive symptoms. While physician ratings are concord ant with patient endorsement of no significant depressive symptomatolo gy 79% of the time, they are only concordant 33% and 13% of the time i n the mild-to-moderate/severe ranges, respectively. Physician ratings were most influenced by patient endorsement of frequent and obvious mo od symptoms, ie, sadness, crying, and irritability. Physician ratings also appeared to be influenced by medical correlates of patients' leve l of depressive symptoms (functional status, stage of disease, and sit e of tumor). Additionally, patients whose depression was inaccurately classified reported significantly higher levels of pain and had higher levels of disability. Physicians' ratings of depression were most hig hly correlated with physicians' ratings of patients' anxiety and pain. Conclusion: Physicians' perceptions of depressive symptoms in their p atients are correlated with patient's ratings, but there is a marked t endency to underestimate the level of depressive symptoms in patients who are more depressed. They are most influenced by symptoms such as c rying and depressed mood, and medical factors that are useful, but not the most reliable, indicators of depression in this population. Physi cians' ratings of their patients' distress symptoms seem to be global in nature-they are highly correlated with anxiety, pain, and global dy sfunction. Physician assessment might be improved if they were instruc ted to assess and probe for the more reliable cognitive symptoms such as anhedonia, guilt, suicidal thinking, and hopelessness. Screening in struments and the use of brief follow-up interviews would help to iden tify patients who are depressed. (C) 1998 by American Society of Clini cal Oncology.