Psychiatry Advisor: Broadly, what is known about the association between depression and mortality in cancer patients? 

Dr Rodin: Clinically significant depression is 2- to 3-times more common in cancer patients than in the general population. It is more likely to occur in cancer patients with more advanced disease, low social support, previous history of depression or other psychiatric illness, and more severe physical symptoms. Depression may adversely affect quality of life and adherence to treatment, and it is associated with a poorer rate of survival.


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Ms Abbitt: Much of the association between mortality and depression in cancer patients is related to lack of recognition of depression symptoms. It has been shown that cancer patients with clinically identified depression have better outcomes when their depression is treated with pharmacologic or psychological support or both. 

Psychiatry Advisor: What are the clinical implications of such findings? 

Dr Rodin: Although it is not clear that depression treatment improves survival, the benefits in terms of quality of life and well-being of cancer patients may be profound. Psychotherapeutic and pharmacologic interventions have both been shown to relieve depression in cancer patients. Antidepressant medication may also be indicated for more severe depressive disorders. Routine distress screening to detect depression may be of value in cancer clinics to enhance detection and treatment of depression. Treatment of pain and other physical symptoms may also be important in relieving and preventing symptoms of depression.

Ms Abbitt: The most important takeaway is to be aware of the signs and symptoms of depression in cancer patients. These symptoms, such as weight loss, change in sleep patterns, loss of appetite, and lack of energy, also occur in cancer patients without depression, and thus these symptoms can be misinterpreted as only part of the course of cancer or treatment. 

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Psychiatry Advisor: What should be the focus of future research in this area?

Dr Rodin: More research is needed on the benefit of routine detection and treatment of depressive symptoms in cancer patients. The results have been promising thus far and suggest that more resources are needed in order for such interventions to become a more routine part of cancer care.

Ms Abbitt: Further research in this area should explore improvements in depression screening and a standardized screening procedure for cancer patients throughout the course of their disease. 

References

  1. Pratt LA, Brody DJ. Depression in the U.S. household population, 2009-2012. NCHS Data Brief. 2014;(172):1-8.
  2. Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr. 2004;(32):57-71. 
  3. Sherrill C, Smith M, Mascoe C, Bigus E, Abbitt D. Effect of treating depressive disorders on mortality of cancer patients. Cureus. 2017;9(10):e1740.
  4. Sullivan DR, Forsberg CW, Ganzini L, et al. Longitudinal changes in depression symptoms and survival among patients with lung cancer: a national cohort assessment. J Clin Oncol. 2016;34(33):3984-3991.
  5. Giese-Davis J, Collie K, Rancourt KMS, Neri E, Kraemer HC, Spiegel D. Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol. 2011;29(4):413-420.
  6. Rieke K, Schmid KK, Lydiatt W, Houfek J, Boilesen E, Watanabe-Galloway S. Depression and survival in head and neck cancer patients. Oral Oncol. 2017;65:76-82. 

This article originally appeared on Psychiatry Advisor