How We Do It

Caring for the “whole person” across the continuum of disease remains a top priority for clinicians. Strides in basic and translational research have opened new therapeutic pathways that provide better targeted and effective treatments with fewer side effects. New ancillary and supportive therapies have transformed and improved the experiences of patients undergoing anticancer treatments. Also, with increasing acceptance of multidisciplinary teams, we have the opportunity to make timely referrals to colleagues who provide supportive and palliative care and targeted interventions to treat pain and disabling symptoms. If our goal is to recognize the full impact of cancer on the lives of patients and their families, it is important to address the emotional and psychological toll of diagnosis and treatment. Recognizing depressive symptoms and clinical depression is an important step toward optimizing the quality of life for patients with cancer.

Data summarized in an excellent review by Pirl published in 2004 show that up to one in five Americans will experience depressive symptoms over the course of their lifetime and that approximately 10%–25% of cancer patients meet criteria for clinical depression.^{[1] and [2]} As our ability to treat depression has improved over the years, thanks in great part to advances in pharmacology and behavioral therapies, it is now critically important to recognize and treat this debilitating disease in individuals with cancer.³ Evidence exists that untreated depression is associated with a worse overall survival for some cancer patients and, paradoxically, that up to half of patients with cancer and concurrent depression are undertreated or receive no treatment.^{[4], [5] and [6]} Medical oncologists receive little or no formal training in psycho-oncology yet are often faced with patients who exhibit changes in mood and become progressively disabled by psychiatric symptoms. Methodical assessment and frequent inquiry may identify patients with cancer and depression.

Peeling Back the Onion: Sorting through Symptoms to Reach a Diagnosis

A diagnosis of cancer often precipitates intense emotions such as fear, sadness, and sometimes anger.² Individuals who may never have given much thought to their own death are confronted with the very real possibility of a shortened life and future suffering. Roles and relationships shift, careers are interrupted, and daily routines may be sacrificed to make room for cancer treatment. Add to this the financial worries that often accompany a serious illness and it is not surprising that patients may require some level of professional guidance or intervention in order to cope with the crisis. As a quick rule of thumb, it takes about 3–4 weeks after diagnosis to adjust, and during that period it is quite normal for patients to experience intense feelings.⁷ Weissman and Worden, among the first psychiatrists to study distress in cancer patients, described an acute syndrome of distress over existential plight with the diagnosis and with a recurrence that lasts about 100 days.⁸ Most individuals, given time and adequate support, will find the inner resources to cope with distressing symptoms and find a new normal. Not all do however, and it is important for oncologists to inquire at regular intervals about how the patient is feeling and coping with illness. A recent study by Lo et al