From OncoLog, August 2013, Vol. 58, No. 8

House Call: Depression in Cancer Patients
Managing depression improves quality of life and possibly cancer treatment outcomes

Depression is a major public health problem, as one in five Americans suffers from depression symptoms at any given time.

The risk of depression is even higher for cancer patients, who are three times more likely to develop depression than the general population. For cancer patients with uncontrolled pain, the risk for depression is even higher.

Cancer patients face many emotional challenges, such as changes in body image, intellectual function, or social function. Patients also may have concerns about death and feelings of disappointment, remorse, or hopelessness. These challenges, along with treatment side effects, can contribute to depression.

Depression and its symptoms

Depression ranges from an everyday emotion to a debilitating mental and physical condition; it can appear as a response to a particular situation or as a chronic disease that goes into remission but can resurface at any time.

The symptoms of depression include:

  • depressed mood,
  • lack of interest in formerly enjoyed activities,
  • significant changes in appetite or sleep patterns,
  • fatigue,
  • inability to think or concentrate,
  • indecisiveness,
  • and recurrent suicidal thoughts.
A person who has several of these symptoms (or either of the first two) for more than 2 weeks may have clinical depression. Left untreated, 66% of clinically depressed people will recover within a year, and 80% recover within 2 years.

Depression and cancer

Unfortunately, many of the symptoms of depression are also side effects of cancer or its treatment, making depression difficult to diagnose in cancer patients. To make matters worse, many cancer treatments—including chemotherapy drugs, radiation therapy, and surgery—can cause depression or symptoms that mimic depression. However, many patients do not report their mental health status to their oncologists.

“The stigma associated with mental illness is such that patients may not volunteer that they are in distress because of shame or fear of compromising treatment,” said Alan D. Valentine, M.D., chair of the Department of Psychiatry at The University of Texas MD Anderson Cancer Center and an expert on depression and cancer. Dr. Valentine added, “Some clinicians assume that depression is a normal part of the cancer experience and thus need not be addressed.”

However, untreated depression has many negative effects on cancer patients. Depression can increase the length and cost of hospitalization, delay treatment, result in treatment noncompliance (such as missing appointments or forgetting to take medicine), and increase stress for caretakers. The most serious danger posed by untreated depression is suicide. Cancer patients are twice as likely as the general population to take their own lives.

Research and treatment

Depression can also physically affect the cancer itself. Several studies have demonstrated that patients affected by depression, stress, and inadequate social support have higher levels of cancer-causing proteins (interleukin-6 and vascular endothelial growth factor) than do patients who have a positive outlook and good social support.

Studies from the past decade in patients with lung cancer, breast cancer, and brain cancer found that depression had a negative impact on overall survival and disease-free intervals.

Depression, however, can be managed effectively in cancer patients. A study from 2011 showed that behavioral interventions prolong survival for cancer patients. These interventions can include methods such as counseling, cognitive behavioral therapy, and antidepressant drugs.

In counseling and cognitive behavioral therapy, physicians or counselors help their patients learn successful strategies for coping with stress and creatively adapt these strategies to address each patient’s current circumstances.

Prescriptions for antidepressants should be carefully coordinated with cancer treatments, as some drug combinations have adverse effects. However, not all side effects are negative; some antidepressants have side effects, such as increased appetite, that can be used to the advantage of cancer patients.

Dr. Valentine emphasized that depression is common, but not normal, in patients with cancer. “That treatment of depression improves quality of life for cancer patients and caregivers is not in dispute,” he said. “There is increasing, encouraging research evidence that such treatment also confers a survival benefit.”

Any cancer patient who has signs of depression should not hesitate to tell his or her doctor; controlling depression can improve or even save the patient’s life.

— J. Delsigne

For more information, talk to your physician, visit www.mdanderson.org, or call askMDAnderson at 877-632-6789. To hear an interview with Dr. Valentine, visit Cancer Newsline.


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