Fast Fact and Concept #7: Depression in Advanced Cancer

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Title: Fast Fact and Concept #7: Depression in Advanced Cancer

Author(s): Warm, E.; Weissman, D.

This Fast Fact includes information about diagnosing depression in advanced cancer. It is suitable for distribution and discussion during ward rounds, or as a teaching tool at the start of an educational conference.

Educational Objective(s)
Review the epidemiology and common signs/symptoms of depression in advanced cancer. Understand the importance of psychological symptom assessment.

Teaching Points
The incidence of depression in cancer patients ranges from 10 to 25 percent, and increases with higher levels of disability, advanced illness, and pain (as high as 77%). The diagnosis of a major depressive syndrome in a terminally ill patient often relies more on the psychological or cognitive symptoms of major depression (worthlessness, hopelessness, excessive guilt, and suicidal ideation) than the usual neurovegetative or somatic signs (terminal illness itself can produce these). Endicott has proposed substitution criteria:

Physical/somatic symptom
1. Change in appetite/weight
2. Sleep disturbance
3. Fatigue, loss of energy
4. Diminished ability to think or concentrate

Psychological symptom substitute
1. Tearfulness, depressed appearance
2. Social withdrawal, decreased talkativeness
3. Brooding, self-pity, pessimism
4. Lack of reactivity

Feelings of hopelessness and worthless must always be explored. While there may not be hope for a cure, many patients can maintain hope for better symptom control, or derive hope by continuing to find meaning in their day-to-day lives. Hopelessness that is pervasive, and accompanied by a sense of despair or despondency, is more likely to represent a symptom of a depressive disorder. Suicidal ideation, even in mild and passive forms, is very likely to be associated with significant degrees of depression in terminally ill cancer patients.

Psychotherapeutic interventions, either in the form of individual or group counseling has been shown reduce psychological stress and depressive symptoms in cancer patients. Antidepressant medications, however, are the mainstay of treatment in cancer patients with a depressive episode.

Breitbart W et.al, in Oxford Textbook of Palliative Medicine, 2nd ed., Doyle D., ed. 1999, pp 937-944.
Endicott J. Measurement of depression patients with cancer. Cancer, 1983;53: 2243-8.

Fast Facts and Concepts are developed and distributed as part of the National Internal Medicine Residency End-of-Life Education project, funded by the Robert Wood Johnson Foundation.

Copyright Notice: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman, D. Fast Fact and Concepts #07: Depression in Advanced Cancer. June, 2000. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 2/2000

Format: Handouts

Purpose: Instructional Aid, Teaching

Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Clergy/Chaplains, Patients/Families, Nurses, Social Workers

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Adult, Psychiatric

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).