1. State the magnitudes of the disparities in depression management among Veterans Integrated Service Network 22 primary care patients with and without cancer or advanced cancer 2. Describe the operationalization of the three depression management quality measures applied in this study Depression is common among patients with cancer, especially advanced cancer. High-quality palliative care for patients with cancer should include appropriate management of depression. We aimed to evaluate depression management quality in patients with cancer and advanced cancer seen in Veterans Affairs (VA) primary care clinics. Data were from primary care patients within Veterans Integrated Service Network 22 (VISN 22) (Arizona, New Mexico, and southern California) during fiscal years 2016-2019. "Patients with cancer" and "patients with advanced cancer" had at least one VA inpatient or outpatient visit with any nonhematological cancer or any advanced or poor-prognosis cancer ICD-10 diagnosis code, respectively, within a fiscal year. Advanced and poor-prognosis cancer codes were selected using previously validated codes. 1,607,447 patient-year observations representing 608,042 individuals constituted the cohort. 8.2% (49,839/608,042) were patients with cancer, and 1.5% (9,278/608,042) were patients with advanced cancer during the study. 30,771 patients (5.1%) died during the study, including 8,327 (16.7%) patients with cancer and 4,117 (44.4%) patients with advanced cancer. Among 15,649 observations of patients who had new episodes of depression, appropriate follow-up rates within 84 and 180 days were 32.2% and 50.2% for the cohort but 22.3% and 38.2% for the 686 any cancer observations and 21.9% and 34.3% for the 73 advanced cancer observations, respectively. Minimally appropriate depression treatment within a year was 76.9%, 68.4%, and 64.4% for cohort, any cancer, and advanced cancer observations, respectively. When patients who died are excluded, appropriate follow-up rates for all, any cancer, and advanced cancer patients within 84 days were 32.3%, 22.6%, and 21.3%; within 180 days they were 50.3%, 38.8%, and 34.4%; and minimally appropriate treatment within a year was 76.8%, 69.2%, and 67.2%. Appropriate management of depression lags for patients with cancer. Care quality gaps for patients with comorbid mental illness and serious illness remain even in health care systems where mental health services are well integrated. [ABSTRACT FROM AUTHOR]