DEPRESSION AND CANCER

Volume 3 Issue 9 September, 2013

Consultation Liaison Psychiatry Focus: Psycho-Oncology

“The good Physician treats the disease, the great physician treats the patient who has the disease” said Sir William Osler.

Likewise treatment of cancer patient is not complete if you do not address the associated psychological distresses with
the disease. Depression is one of the common psychiatric conditions seen in patients diagnosed with cancer. Fatigue,
decreased appetite and sleep problems which are usually considered to be due to cancer and its therapies may be
primarily related to depression itself. 40 to 50% of cancer patients have some depressive symptoms before, during or
after cancer directed therapy. It has to highlighted here that depression may not be just psychological reaction to
diagnosis of cancer. Some cancers like that of head of pancreas may present with depression for the very first time
itself, even the chemotherapy and other interventions can impair the biological system, that lead to depression.

Symptom formation:

The word ‘cancer’ itself brings distress in the minds of patients. It is conceived as a noncurable, painful condition with
lengthy, costly treatment and fatal outcome.
The patient once diagnosed with cancer, do not accept the diagnosis initially, may deny it, they take 2-3 opinions, then
goes through the phases of blaming his fate, god and may develop depression early.
Series of various diagnostic investigations that the patient undergoes like CT, MRI, PET CT, Endoscopies and biopsy for
diagnosis and staging of cancer add to the distress.
Going through various treatments and its associated side effects also cause depression. The changes in physical
appearance due to surgical procedures like loss of breast in a woman, facial disfigurement in head and neck cancer
surgeries, loss of a limb in extremity cancer surgeries make the patient go through depression.
The chemotherapy with its associated nausea, vomiting and especially hair fall makes the patient avoid social company.
The Radiotherapy side effects like skin and mucosal reactions, diarrhea, swallowing difficulties increase the level of
depression which is already there with diagnosis.
The prolonged treatment with its associated financial implications makes the patient feel guilty of being burden to his
family and make him depressed.
During follow-up visits also, every time he undergoes investigations, he goes through the fear of re-detecting the disease and depression.

Diagnosis:

National comprehensive cancer network guidelines version 2011, has set a screening tool in the form of distress
thermometer to identify the kind of distress the patients are undergoing. Hamilton Depression Rating Scale (HAM-D)
and Becks depression inventory (BDI) are the most widely used instruments for measuring the severity of depression.

Remedial measure:

Every patient once diagnosed with cancer should also be evaluated by qualified clinical psychologist or a colleague
Psychiatrist, who will diagnose and assess the severity of depression; throughout the course of diagnosis, treatment and follow-up of cancer patient and initiate the necessary treatment. Appropriate pharmacotherapy and psychological
interventions help the patient in coping up with all aspects of disease and its management. The family members also
undergo psychological distress as the fear of losing their loved one looms over them. It is essential to deal with them
also as they form important support group for the patient who is going through the turmoil. This is an important area
where more Indian studies are needed. Oncologist, psychiatrist, clinical psychologist should interact & discuss the
evidence based strategy to optimize cancer patient care.