An attempt to employ the Zung Self-Rating Depression Scale as a "lab test" to trigger follow-up in ambulatory oncology clinics: criterion validity and detection.

We examined issues of criterion validity and detection of depression employing the Zung Self-Rating Depression Scale (ZSDS) as a "lab test" to trigger follow-up interviews of ambulatory oncology patients by oncology staff and the possibility of subsequent algorithm-based antidepressant treatment. Sixty oncology patients were screened with the ZSDS and then interviewed using the Mini-International Neuropsychiatric Interview (MINI). We examined the sensitivity and specificity of various cutoffs on the ZSDS and a briefer version, the Brief Zung Self-Rating Depression Scale (BZSDS) as they predicted results of the MINI, which was used as the criterion. Mean age of patients was 58.3 years (SD = 11.9). Thirty-two were female (53.3%) and 28 were male (46.7%). The correlation of the ZSDS (r = -0.66, P <.0001) and BZSDS (r = -0.57, P <.0001) with the MINI overall suggested acceptable levels of criterion validity. Additionally, we examined various cutoff scores on the ZSDS and BZSDS to explore the false negative and false positive rates that are associated with each. For example, using the mild cutoff on the Zung (score > 48) to determine depression or adjustment disorder, 14 false negatives and 2 false positives were found. When the more stringent moderate cutoff (score > 56) was used, 25 false negatives and 0 false positives were found. Oncology staff can utilize such data to make decisions about where to set cut-offs that trigger follow-up based on the amount of error that is allowable in their attempts to identify depressive symptoms in their patients. We discuss that such decisions might be based on many factors including the resources available in a particular site for follow-up or the comfort of particular oncologists and nurses managing and prescribing psychotropic medications, or in providing supportive counseling.

Oncology staff recognition of depressive symptoms on videotaped interviews of depressed cancer patients: implications for designing a training program.

We examined oncologists' and nurses' ability to recognize depressive symptoms in two cancer patients who were interviewed on videotape. The study was conducted in a rural community, hospital-based outreach network. Staff were given a one-hour in-service on the use of the Mini International Neuropsychiatric Interview (MINI)-a brief diagnostic interview-to provide a differential diagnosis (no psychiatric diagnosis, major depressive disorder, or adjustment disorder with depressed mood). Next, the staff viewed a videotape of an investigator (S.P.) utilizing the MINI to interview two depressed breast cancer patients. Staff subsequently rated depressive symptoms on the MINI and made a diagnosis. Findings indicated a high concordance among staff regarding symptom ratings on a straightforward example of major depressive disorder. Concordance on diagnosis, severity level, and specific symptoms declined slightly on a more difficult case involving primarily cognitive symptoms and a diagnosis of adjustment disorder. Following brief didactic training on depressive disorders, oncologists and nurses were able to identify depressive symptoms in cancer patients on videotape. Learning to use a semistructured interview can increase oncologists' awareness of depressive symptoms and may be a good training model.

Factor analysis of the Zung Self-Rating Depression Scale in a large ambulatory oncology sample.

Screening cancer patients for depression with self-report inventories presents clinical and methodological challenges. Many investigators separate "somatic" from "cognitive" symptoms when adapting such measures to oncology settings. However, this practice has rarely been empirically validated through factor-analytic studies. The following study describes a factor analysis of the Zung Self-Rating Depression Scale (ZSDS) from a large ambulatory sample of cancer patients (N = 1,109). A four-factor solution emerged, consisting of a cognitive symptom factor, a manifest depressed mood factor, and two somatic factors (eating and non-eating related). These factors accounted for 20% (cognitive), 13% (mood), 8% (non-eating), and 7% (eating) of the variance on the Zung, respectively. The authors discuss the implications of these results as they pertain to screening cancer patients for depression.

A psychosocial intervention for patients with soft tissue sarcoma.

Support groups have increasingly been demonstrated to be an effective intervention in reducing psychological difficulties and emotional problems in patients with cancer. This report describes a pilot support group intervention based upon a modified version of Cain and colleagues' (1986) thematic counseling model for patients who have been treated for soft tissue sarcoma and are free of disease. The modified thematic counseling model consisted of eight group sessions that focused on providing information about soft tissue sarcoma, management of stress, relaxation techniques, and coping skills. In addition, time was set aside for general discussion of personal concerns. Common themes reported by patients were: communication with family, friends and physicians, anxiety about lack of information about soft tissue sarcoma, and major financial disruption because of their illness. At the conclusion of the eighth session, patients were given an informal survey and asked to rate the value of different aspects of the program for them. They reported that feelings of isolation, anger, depression, and anxiety significantly decreased; and their level of self-confidence increased dramatically. This pilot support group intervention is recommended as a model for enhancing the quality of life of patients with soft tissue sarcoma.

Alcohol and cancer: a review for psycho-oncologists.

Researchers have documented a link between alcohol consumption and the development of certain types of cancers. In addition, the prevalence of alcoholism and comorbid psychiatric disorders has been well-documented both the general population and medical settings. The role of the psycho-oncologist in the assessment and management of alcoholism and comorbid psychiatric disorders is crucial to improving both treatment adherence and the quality of life of the patient. This paper will provide psycho-oncologists with a review of: (1) the relationship of alcoholism to cancer; (2) psychiatric comorbidity frequently encountered in alcoholics, as a key to assessment and management; and (3) the goals and strategies of management of alcoholic cancer patient.