Suboptimal depression screening following cancer diagnosis

Abstract

Objective To describe the proportion of veterans with cancer screened for depression as compared to the general population (GenPop) of veterans. Methods Data were abstracted from electronic medical records (2000–2004) at a Midwestern Veterans Health Administration (VHA) facility and from the VHA External Peer Review Program (EPRP). Depression screening was assessed in the 12-month period following cancer diagnosis or in the 12-month period prior to EPRP medical record abstraction. Statistical analysis included multivariate logistic regression. Results Annual depression screening among veterans with cancer improved from 42% in 2000 to 81% in 2003. Screening was 9–31% lower and 11–50% lower among veterans with cancer at the Midwestern facility, as compared to the GenPop of veterans nationwide and at the Midwestern facility, respectively. Of subjects with cancer at the Midwestern facility, 19% screened positive. Advanced disease [odds ratio (OR)=0.51; 95% confidence interval (CI 95): 0.38–0.68] and respiratory cancers (OR=0.55; CI 95: 0.38–0.80) were associated with lower odds of screening receipt. Conclusions Screening for depression among veterans with cancer improved 39% but is considerably lower than the proportion of GenPop veterans screened nationally and at the local facility. Targeted interventions to improve screening in patients with cancer are required based on evidence that screening translates into increased provider recognition and treatment of depression.