Depression in patients with advanced cancer

Sadness is a normal reaction to the fears, anxieties, and uncertainties during any stage of cancer but is especially problematic during the advanced stage. Depressive symptoms and syndromes frequently coexist during this time and affect quality of life. Depression is an overlooked and undertreated symptom during late-stage cancer. This article provides an overview of the epidemiology, neurophysiology, diagnostic and screening approaches, risk factors, and treatment modalities for depression in patients with advanced cancer.     

Depression and chronic fatigue in cancer patients

Fatigue is a very common symptom among cancer patients. It is crucial to diagnose those patients for whom the fatigue is a symptom of depression, and to treat them appropriately. The key to providing complete and satisfying care is to identify and address the psychologic, social, and medical vulnerabilities of each cancer patient. No one is in a better position to accomplish that than the primary physician.     

Depression and hopelessness in Turkish patients with cancer undergoing chemotherapy

Aim: This study aimed to determine the levels of depression and hopelessness of patients receiving chemotherapy. Through knowledge of the levels of hopelessness and depression in such patients, this study could contribute to the planning of nursing interventions. Methods: The study involved 101 patients with cancer who presented to the outpatient unit of a medical oncology clinic to receive outpatient chemotherapy between January and March 2006. Data on the patients' sociodemographic features, as well as their scores on the Beck Hopelessness Scale and the Beck Depression Inventory, were obtained. Results: The patients' mean total depression score was 16.0 ± 8.3 and their mean hopelessness score was 6.9 ± 3.4. There was a statistically significant positive relationship between depression and hopelessness. Conclusion: The results indicated that depression and hopelessness were strongly and positively correlated.     

Depression in advanced cancer

PurposeDepression is one of the most common psychiatric diseases seen in patients with advanced cancer. It is not only an independent predictor of poor survival in advanced cancer but also reduces quality of life, reduces compliance with treatment and prolongs hospitalization. Yet all too often depression is under diagnosed and under treated in this population.MethodA literature review was undertaken using extensive electronic and hand searches.Key findingsWhilst it is true that the diagnostic and treatment challenges facing healthcare professionals in this area are considerable one must not forget that depression in advanced cancer is treatable and validated assessment tools have been developed to facilitate diagnosis.ConclusionsThis review article provides the reader with a comprehensive review of the current evidence in this field with particular focus on assessment and treatment. Depression is under diagnosed and under treated – there are valid screening and assessment tools available which will allow appropriate management of this important and debilitating symptom.     

Depression in children with cancer

In this study, children with cancer and healthy students between the ages of 9 and 13 were investigated in terms of depression status. A demographic data form and the Children's Depression Inventory were given to both groups. The research group consisted of 50 children with cancer who were followed up in pediatric hematology and oncology outpatient clinics at Ankara University. The control group was comprised of 50 healthy students who attended Türk?zü Timur Primary School. It was found that there were significant differences between depression scores of children with cancer and children that are healthy. Children with cancer have higher depression scores than healthy students.     

Depression and use of health care services in patients with advanced cancer

Objective

To examine whether depression in patients with advanced cancer is associated with increased rates of physician visits, especially to primary care.

Design

Retrospective, observational study linking depression survey data to provincial health administration data.

Setting

Toronto, Ont.

Participants

A total of 737 patients with advanced cancer attending Princess Margaret Hospital, who participated in the Will to Live Study from 2002 to 2008.

Main outcome measures

Frequency of visits to primary care, oncology, surgery, and psychiatry services, before and after the depression assessment.

Results

Before the assessment, depression was associated with an almost 25% increase in the rate of primary care visits for reasons not related to mental health (rate ratio [RR] = 1.23, 95% CI 1.00 to 1.50), adjusting for medical morbidity and other factors. After assessment, depression was associated with a 2-fold increase in the rate of primary care visits for mental health–related reasons (RR = 2.35, 95% CI 1.18 to 4.66). However, depression was also associated during this time with an almost 25% reduction in the rate of oncology visits (RR = 0.78, 95% CI 0.65 to 0.94).

Conclusion

Depression affects health care service use in patients with advanced cancer. Individuals with depression were more likely to see primary care physicians but less likely to see oncologists, compared with individuals without depression. However, the frequent association of disease-related factors with depression in patients with advanced cancer highlights the need for communication between oncologists and primary care physicians about the medical and psychosocial care of these patients.     

Depression and the use of complementary medicine among breast cancer patients

This was a cross-sectional study to examine the association between anxiety, depression and quality of life and the use of complementary and alternative medicine. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS), and quality of life was measured using the global quality of life subscale selected from the European Organization for Treatment and Research of Cancer (EORTC) quality of life core questionnaire (QLQ-C30). In all, 177 breast cancer patients were studied, and 32% (n=57) reported that they used or were using complementary medicine. Users and nonusers did not differ significantly in almost all variables studied, with the exception of duration of their diagnosis. The most commonly used complementary medicine was prayer and spiritual healing (n=45, 73.8% of responses). Performing the logistic regression analysis controlling for age, marital status, educational level, knowledge of diagnosis, time since diagnosis, global quality of life, depression, and anxiety scores, the results indicated that the use of complementary medicine among breast cancer patients was associated with sever depression (odds ratio 2.49, 95% CI 1.06–5.89, P 0.04). The other variables studied did not show any significant results. The study findings confirm that the use of complementary medicine is more common among depressed breast cancer patients and might be a marker of greater psychological distress in this group of patients.The preliminary results of this study was presented at the 4th European Breast Cancer Conference, Hamburg, Germany, 16–20 March 2004     

Depression and pancreatic cancer

Depression and psychological distress appear to be greater in patients with pancreatic cancer, compared to other equally ill patients with cancer, including those with other abnormal neoplasms. The several hypotheses regarding etiology are unproven, but the possibility of a tumor-related paraneoplastic syndrome which promotes the production of a false neurotransmitter capable of altering mood appears most logical at present. However, patients with pancreatic cancer have tumors with known poor prognosis and they often have pain. Both factors contribute to depression. Management of depression depends upon attention to adequate pain control, use of antidepressants and psychological support. Depression in pancreatic cancer raises challenging questions, both about its cause and treatment. Further research study of its psychological and biological components is important in oncology.     

Depression in husbands of breast cancer patients: relationships to coping and social support

Purpose  

The purpose of the present study was to examine depression in husbands of women with breast cancer, as depression is typically as high in husbands as in patients, and impacts functioning in both.     

阿尔茨海默病患者的抑郁症

阿尔茨海默病 (Alzheimer’sdisease ,AD )是一种进行性神经变性疾病 ,其病理特点是脑皮层广泛神经元缺失、β 淀粉样肽(Aβ)聚集形成老年斑和神经纤维缠结。临床上以隐匿的记忆和其他认知功能减退并发展为严重痴呆为特征。目前 ,中国约有AD患者 5 0 0万人 ,占世界总病例数的 1/4以上 ,而且平均每年还有 3 0万老年人加入这个行列。老年性痴呆已是老年人死亡的第 4大原因。抑郁症 (depression)的症状可概括为情绪低落、思维缓慢和动作减少 3个主症及其他表现 ,主要有对日常活动丧失兴趣、无愉快感、精力明显减退、无原因的持续疲劳感、言…     

Depression in post-acute myocardial infarction patients

PURPOSE: To identify strategies for nurse practitioners to diagnose and treat depression following acute myocardial infarction (AMI) and prevent subsequent cardiac events. DATA SOURCES: Selected articles in the medical and psychiatric literature and government consensus guidelines. CONCLUSIONS: Between 8% and 45% of patients who have suffered an AMI exhibit symptoms of major depression. Depression is an independent risk factor for cardiovascular disease and causes higher morbidity and mortality rates among patients with coronary artery disease. IMPLICATIONS FOR PRACTICE: Early diagnosis and aggressive treatment are crucial to reducing cardiac related morbidity and mortality. Cardiac rehabilitation programs, psychotherapy and counseling, and pharmacotherapy are effective in the management of AMI depression.     

The Hospital Anxiety and Depression Scale in Greek cancer patients: psychometric analyses and applicability

Goals of work The aim of the present study was to validate the Greek version of the Hospital Anxiety and Depression Scale (HAD) in a palliative care unit.Patients and methods The scale was translated with the forward-backward procedure to Greek. It was administered twice, with a 1-week interval, to 120 patients with advanced cancer. Together with the HAD scale, the patients also completed the Spielberger State-Anxiety Scale (STAI-S).Main results Factor analyses identified a two-factor solution corresponding to the original two subscales of the HAD, which were found to be correlated. The Greek version of the HAD had Cronbachs alphas for the anxiety and depression scales of 0.887 and 0.703, respectively. Validity as performed using known-group analysis showed good results. Both anxiety and depression subscales discriminated well between subgroups of patients differing in disease severity as defined by ECOG performance status. Correlations between the HAD scale and the STAI-S was 0.681 for the anxiety subscale and 0.485 for the depression subscale.Conclusions These psychometric properties of the Greek version of the HAD scale confirm it as a valid and reliable measure when administered to patients with advanced cancer.     

Depression and anxiety disorders in palliative cancer care

Depression and anxiety disorders are thought to be common in palliative cancer care, but there is inconsistent evidence regarding their relevance for other aspects of quality of life. In the Canadian National Palliative Care Survey, semi-structured interviews assessing depression and anxiety disorders were administered to 381 patients who were receiving palliative care for cancer. There were 212 women and 169 men, with a median survival of 63 days. We found that 93 participants (24.4%, 95% confidence interval=20.2-29.0) fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for at least one anxiety or depressive disorder (20.7% prevalence of depressive disorders, 13.9% prevalence of anxiety disorders). The most frequent individual diagnosis was major depression (13.1%, 95% confidence interval=9.9-16.9). Comorbidity was common, with 10.2% of participants meeting criteria for more than one disorder. Those diagnosed with a disorder were significantly younger than other participants (P=0.002). They also had lower performance status (P=0.017), smaller social networks (P=0.008), and less participation in organized religious services (P=0.007). In addition, they reported more severe distress on 14 of 18 physical symptoms, social concerns, and existential issues. Of those with a disorder, 39.8% were being treated with antidepressant medication, and 66.7% had been prescribed a benzodiazepine. In conclusion, it appears that depression and anxiety disorders are indeed common among patients receiving palliative care. These disorders contribute to a greatly diminished quality of life among people who are dying of cancer.     

Depression in patients with chronic venous ulceration

As leg ulcer research has generally focused on aspects of treatment, the psychosocial impact of leg ulceration remains understudied. This article reports the findings of a study exploring the prevalence of anxiety and depression in 190 patients with chronic venous ulceration across 9 Trusts in the northwest of England. The hospital anxiety and depression scale (HADS) was used to screen patients for the presence of anxiety and depression using a cut-off point of 9 for level of "caseness". A total of 52 (27%) people scored as depressed while 50 (26%) scored as anxious. The two symptoms which appeared to be associated with anxiety and depression were pain and odour, while there was no association found between living alone, mobility and exudate. These findings suggest that the focus of care needs to be redirected for many patients for whom cure is not an option, but who are left to live with a chronic wound. Furthermore, psychological factors, including depression, should be a focus in assessment and ongoing review of patients with leg ulceration.     

Depression in patients of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a psychosomatic disorder which onset and course is affected by psychological factors. It is also said that IBS symptoms and psychiatric symptoms are strongly related. In some reports, 29% of IBS patients consulting doctors were also diagnosed with major depression. There are also records that the consolidation of depression, panic disorder, and neurosis contributes to poor outcomes in serious cases of IBS. In this report, we have indicated the diagnosis and treatment of depression in primary care. For diagnosis, detailed medical interviews and use of psychological tests such as SDS or SRQ-D are recommended. Some types of anti-depressants are also effective for IBS symptoms as well as psychiatric problems. We suggest that treatment of psychological factors should also be considered when dealing with IBS.     

Depression and family interaction among low-income, predominantly hispanic cancer patients: a longitudinal analysis

Purpose

Among cancer patients, family interaction has been associated with depression. According to the stress generation theory, depression among cancer patients triggers stressful interpersonal events that contribute to poor family interactions and additional depression. This conflict may occur with a spouse/partner or other family member, including extended family. This study evaluated the longitudinal association between depression and marital and family conflict among low-income, predominantly Hispanic cancer patients.

Methods

Data were collected during a randomized controlled clinical trial of depression treatment among 472 low-income cancer patients with baseline depression scores of 10 or more on the Patient Health Questionnaire-9 and whose depression symptoms and negative family interactions were assessed at baseline and at 6, 12, 18, and 24 months. Considering that not all participants were in an intimate relationship, only 237 participants were included in the analysis of marital conflict. Mixed linear modeling with and without decomposition of between- and within-person variability was conducted to examine the longitudinal association between family interaction and depression.

Results

Overall, family conflict was significantly associated with changes in depression over time, and marital conflict was significantly associated with mean depression levels over 2 years. In addition, within-subject change in both marital and family conflict was significantly associated with within-patient deviation from average depression levels.

Conclusions

Findings provide evidence of an association between depression and negative family interaction among depressed cancer patients. Cancer patients with clinically significant depressive symptoms may benefit from clinical assessment and psychotherapy relevant to family interaction.     

血液透析患者抑郁状态及其相关因素分析

目的探讨终末期肾脏疾病(ESRD)血液透析患者抑郁的发生率及其影响因素。方法采用贝克抑郁量表(BDI)对124例ESRD血液透析患者进行抑郁状态评估,并比较抑郁组和非抑郁组的一般情况及实验室指标。结果 BDI评分显示纳入研究的患者抑郁的患病率为56.5%。抑郁组和非抑郁组比较,性别构成和就业情况的差异有统计学意义(P0.05),女性和非在职患者抑郁情绪出现的概率较高;两组患者在年龄、透析时间、文化程度、婚姻状况、经济情况方面进行比较,差异均无统计学意义(P0.05)。在实验室检查方面,抑郁组白细胞以及血尿酸水平均高于非抑郁组,差异有统计学意义(P0.05)。结论 ESRD血液透析患者抑郁的发生率较且好发于女性和非在职患者,同时伴随较高的白细胞和尿酸水平。     

Depression predicts disability in long-term chronic pain patients

Purpose : Investigators have examined factors that predict treatment outcome and disability status in chronic pain patients, including psychopathology and personality characteristics with equivocal results. The purpose of this study was to evaluate the usefulness of personality characteristics, depression, and personality disorders in predicting disability status in pain patients with long-term follow-up. The setting was a rehabilitation hospital in Southern Sweden. Method : Subjects were 184 pain patients (mean age=43.4 (10.8) years; 72.8% female) who had no more than 365 sick leave days (Mean sick leave days=132.7 (128.2)) prior to the baseline personality and psychiatric evaluation. The baseline evaluation consisted of a psychiatric interview that included the administration of the Structured Clinical Interview for DSM-IV Screen Questionnaire (SCID-II), the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Karolinska Scales of Personality (KSP). Disability status was assessed by insurance record review a minimum of two-and-a-half years after baseline evaluation. Results : Multivariate logistic regression suggests that age (OR=1.09, 95% CI=1.02-1.18; p =0.013), number of sick leave days prior to evaluation (OR=1.01, 95% CI=1.01-1.02; p =0.018), and baseline diagnosis of depression significantly predicted subsequent disability status (OR=7.04, 95% CI=1.15-42.93; p =0.034). Baseline personality traits and the diagnosis of a personality disorder were not useful predictors of disability status in our sample. Conclusions : These data suggest that depression, but not personality disorders characteristics, was an important disability predictor in chronic pain patients with extended follow-up.