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J Pain Symptom Manage. 2019 Mar;57(3):587-595. doi: 10.1016/j.jpainsymman.2018.11.024. Epub 2018 Dec 1.

Opportunities to Improve Detection and Treatment of Depression Among Patients With Breast Cancer Treated in an Integrated Delivery System.

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Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address:
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Kaiser Permanente Northern California Vallejo Medical Center, Vallejo, California, USA.
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.



Patients with cancer commonly experience depression. If not addressed, depression can lead to reduced quality of life and survival.


Given the introduction of national initiatives to improve management of psychiatric symptoms among patients with cancer, we examined patterns of depression detection and treatment over time, and with respect to patient characteristics.


This cross-sectional study linked data from the Pathways Study, a prospective cohort study of women diagnosed with breast cancer at Kaiser Permanente Northern California between 2005 and 2013, with data from Kaiser Permanente Northern California's electronic medical record. Pathways participants eligible for this analysis had no known prior depression but reported depressive symptoms at baseline. We used modified Poisson regression to assess the association of cancer diagnosis year and other patient characteristics with receipt of a documented clinician response to depressive symptoms (depression diagnosis, mental health referral, or antidepressant prescription).


Of the 725 women in our sample, 34% received a clinician response to depression. We observed no statistically significant association of breast cancer diagnosis year with clinician response. Characteristics associated with clinician response included Asian race (adjusted risk ratio, Asian vs. white: 0.44, 95% CI: 0.29-0.68) and depression severity (adjusted risk ratio, mild-moderate vs. severe depression: 1.45, 95% CI: 1.11-1.88).


Most patients in our sample did not receive a clinician response to their study-reported depression, and rates of response do not appear to have improved over time. Asian women, and those with less severe depression, appeared to be at increased risk of having unmet mental health care needs.


Breast neoplasms; delivery of health care; depression; health services research; practice guideline

[Available on 2020-03-01]

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