From OncoLog, August 2013, Vol. 58,
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:
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.
- depressed mood,
- lack of interest in formerly enjoyed activities,
- significant changes in appetite or sleep patterns,
- inability to think or concentrate,
- and recurrent suicidal thoughts.
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
“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
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
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