Background: Cancer is commonly associated with depression and depressive symptoms. Depressive disorders often worsen over the course of cancer treatment, persist after cancer therapy, recur with the recurrence of cancer and impact on function and medical outcomes. We aimed at assessing whether depression management could happen at the cancer center without referral to the mental health clinic.
Methods and materials: We conducted a quasi-experimental study for screening and treatment of depressive symptoms among patients living with cancer, who were attending oncology services at Kamuzu Central Hospital between May, 2021 and August, 2022. The intervention arm had screen and treat for depressive symptoms as an integrated approach to cancer care within the study site while the comparison arm had screen and refer patients diagnosed with depressive symptoms to usual mental health clinic. Patients were followed-up for six months and health related quality of life was measured using Euroqol-5 dimession-3 levels tool during each visit. Depressive symptoms were evaluated using the Patient Health Questionnaire-9.
Results: There were 214 participants in the study; 112 in the comparison and 102 in the intervention group. The majority (65%) were females and at least 36% of the participants were in the middle age group (26-45 years); 29% of the participants had unknown HIV status. Participants of high socio-economic status were twice more likely to report poor quality of life than those with lower socio-economic status 1.99 (95% CI: 1-12-3.53, p<0.02). Employed participants were less likely to report poor quality of life 0.62 (95% CI: 0.42-0.90, p<0.01). Poor quality of life was steadily declining with each successive clinic visit, 0.07 (95% CI: 0.05-0.10, p< 0.001) and there were similar patterns of improvement in quality of life between study arms, 1.06 (95% CI:0.73-1.54, p<0.77).
Conclusion: Depression screening and treatment could be integrated within the cancer care for improved quality of life in Malawi. While persons accessing care within hospital can benefit from HIV testing and referral for treatment if found HIV positive, Malawian cancer patients at Kamuzu Central Hospital might not have benefitted from these services as a handful of participants in our study had not been tested.
Keywords: Quality of life; Cancer; Depression