Helping the whole patient

Karen Weihs, MD
Karen Weihs, MD

Cancer is a disease that attacks more than just a patient’s cells. It often wreaks havoc on an individual’s emotional equilibrium, as well. Karen Weihs, MD, is among the researchers attempting to identify patients who exhibit depressive symptoms in order to help them successfully fight cancer on every level — physically and emotionally.

As the medical director for Supportive Care for Healing and Psychosocial Oncology at the University of Arizona Cancer Center, Dr. Weihs specializes in psychiatric and survivorship care, as she and her team provide whole-person cancer care for patients and their families.

In 2008, Dr. Weihs, along with a handful of the UACC’s top oncologists, including Alison Stopeck, MD, developed a program called COPE-D (the Collaborative Oncology Program to Enhance Depression care). Their work was motivated by the evidence that cancer patients who also suffer from depression do significantly worse in their treatments than their non-depressed counterparts.

“We’ve found that depressed cancer patients suffer from more physical pain and their bodies may not be as responsive to chemotherapy or other treatments,” Dr. Weihs said. “On a purely physiological level, the depressed patient is at a disadvantage.
The odds of survival decrease.”

The COPE-D project attempts to identify patients with depressive symptoms and intervene with biopsychosocial treatments as part of their comprehensive care.

During the original screening process five years ago, Dr. Weihs’ team of medical assistants and nurse coordinators found that 15 percent of the 1,500 patients who took part in the study had elevated symptoms of depression for two weeks or more. It took the team more than three years to collect the pilot data, which showed a greater resolution of depression for the people who received intervention with the team of social workers, oncologists, nurses and psychiatrists versus those who didn’t.

The key to COPE-D was determining which patients were genuinely depressed versus patients who simply felt sad.

“Feeling down is normal when you have cancer, so it was important to make the distinction,” Dr. Weihs said.

In order to fit the criteria for a depressive disorder, Dr. Weihs said, a patient must lose interest in his or her normal activities or experience feeling sad for more than half the time for two full weeks. These are the patients who become markedly different people than they were prior to entering a depressive state, as well as the patients who often give up on their treatment before it can begin to take effect.

In the original study, the rate of resolution for depression symptoms was 25 percent, after patients and their doctors simply received the information about their symptoms. After social worker intervention, supported by the multidisciplinary team, the rate of resolution rose to 65 percent.

Dr. Weihs restarted screening for depression and implementation of the COPE-D intervention with Dr. Lee Cranmer’s multidisciplinary team in January 2013. Shawn Mulligan, RN, BSN, MS, program coordinator for the Supportive Care for Healing team, is leading the effort to re-establish the protocol. The clinic’s medical assistants screen patients when they are being prepared for a visit with Dr. Cranmer and nurse practitioner Agnes Yahl, FNP-C. Patients who exhibit an elevation in depressive symptoms then take a more extensive assessment, which tells the doctors and nurses whether these patients had a likelihood of a depressive disorder.

These patients are then seen by one of the UA Cancer Center’s social workers to discuss their options and receive further education and initiation of treatment for depression with the multidisciplinary team.

The COPE-D model is also being used in the hemophilia clinic, led by Dr. Stopeck. The Supportive Care for Healing team hopes to make this approach the standard of care for the entire oncology practice in the future.

“It’s a layered, collaborative approach to patient care,” Dr. Weihs said. “When you treat the whole patient — their body, their mind, and their spirit — you can accomplish some pretty amazing things.”

-Nick Prevenas, Feb. 19, 2013