Elsevier

The Lancet Oncology

Volume 2, Issue 8, August 2001, Pages 499-505
The Lancet Oncology

Review
Depression in cancer patients

https://doi.org/10.1016/S1470-2045(01)00456-9Get rights and content

Summary

Clinical depression is a relatively common, and yet frequently overlooked, source of suffering among patients with cancer. All patients who face a life-threatening diagnosis such as cancer experience a normal albeit painful emotional reaction, but a substantial minority will become clinically depressed. This article reviews some basic information that oncology practitioners may find helpful in identifying patients at risk of experiencing a major depression. A brief overview of the epidemiology, diagnostic criteria, screening approaches, and special issues, such as depression in the elderly, high-risk populations, and suicide is also provided.

Section snippets

Definition of depression

Each of us will experience a range of profound emotions in response to a life-threatening illness such as cancer. The ominous implications and uncertainty of such a diagnosis will lead to intense feelings, usually including a sense of shock or disbelief, followed by a period of turmoil associated with symptoms of anxiety and sadness, irritability, sleep loss (Figure 1) and disturbance of appetite. After a period of several weeks, however, most patients experience a certain degree of resolution,

Prevalence of depression among cancer patients

Published information on the prevalence of depression in patients with cancer is not easy to interpret. Reported rates of depression varied from 1% among patients with acute leukaemia to over 40% of patients with other malignant diseases.9,10 In addition, there are methodological inconsistencies and differences, making cross-study comparisons difficult, but also explaining some of these apparent discrepancies.11, 12, 13 A frequently cited study by Derogatis and colleagues involved 215 randomly

Screening for depression

If clinical depression affects one to three of every ten patients with cancer, why do so few individuals receive treatment for this condition? The variation in reported prevalence rates, and the non-specificity of somatic (physical) symptoms, suggest that making a diagnosis of depression in these patients is challenging. In a study of 200 patients with advanced malignant disease, our group reported that single-item screening – in other words, simply asking the question “Are you depressed most

Patients with cancer at highest risk of clinical depression

Various factors increase the risk of patients with cancer developing clinical depression.17 If a patient has a history of depression, with two or more episodes during their lifetime, they are at higher risk of developing a subsequent depressive episode. Patients whose initial episode began early in life, and older patients who have had their first episode late in life, are thought to be at higher risk of relapse. In addition, patients who have a family history of depression or suicide, as well

Elderly depressed cancer patients

The elderly are at greater risk of both depression and suicide.28, 29 Suicide is the third leading cause of death among the elderly. Although older patients are less likely than younger people to attempt suicide, they tend to be more successful. Suicide peaks after the age of 45 in men, and after the age of 55 in women. Over the age of 65, the incidence of suicide is about 40 per 100 000, with elderly people accounting for about 6200 deaths in the USA annually. Therefore, although the elderly

Suicide and desire for death

Suicide and a desire for death are particularly serious consequences of depressive syndrome; depression is a factor in about 75% of all completed suicides. The suicide rate in the general US population is about 12 per 100 000 or 32 000 deaths per year.33, 34 Cancer patients are thought have a risk of suicide about twice that of the general population.16, 18 Several risk factors have been reported, and the ability to recognise these is the starting point for any prevention strategy. These

What can be done about depression in cancer patients?

When treating clinical depression in cancer patients, one must first address the issue of nihilism. Therapeutic nihilism absolves care-givers from responding to the patient's suffering, mistakenly dismissing even the most extreme distress as expected or somehow normal. Elimination of therapeutic nihilism and the ability to differentiate between patients experiencing clinical depression and those showing a normal emotional response to their illness are the first necessary steps. Pharmacotherapy

Conclusions

Sadness is a normal reaction to the many fears, anxieties, and uncertainties caused by a diagnosis of cancer. Clinical depression, on the other hand, is a serious psychiatric complication that can affect many such patients, causing significant additional suffering. Oncology care providers must therefore be able to recognise clinical depression, and should be familiar with the diagnostic approaches that are available. Both psychological and psychopharmacological treatments are effective in

Search strategy and selection criteria

Data for this review were identified by a search of MEDLINE. Articles were selected on the basis of their clinical relevance to oncology care providers. With similar inclusion criteria, the reference lists from relevant chapters within the following textbooks were considered: Doyle D, Hanks J, MacDonald N (Eds). The Oxford textbook of palliative medicine, 2nd ed. New York: Oxford University Press, 1999; Holland J (Ed) Psycho-oncology. New York: Oxford University Press, 1998; Chochinov HM,

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