All oncologists face treating patients with varying forms of emotional distress. In this issue of the Journal of Supportive Oncology, Morgans and Schapira's “Recognizing Depression in Patients with Cancer” offers a front-line approach to treat clinically depressed cancer patients. Meyer and Block's “Personality Disorders in the Oncology Setting” provides oncology clinicians with practical tips on how to manage behaviorally “difficult” patients.

Morgans and Schapira define cancer treatment as a marathon. Oncologists have the perspective of seeing their patient as a “whole person” over time. They can pick up on potential indicators of emerging depressed mood, such as distress and loss of characteristic resiliency. Similarly, as the “quarterbacks” of well-functioning interdisciplinary teams, oncologists can screen for depression and initiate pharmacotherapy before calling in the special teams (psychiatry, psychology, social work, clergy, etc.).

Not all oncologists are ready to embrace the holistic quarterback approach. Fortunately, the National Comprehensive Cancer Network's guidelines for distress management¹ identify screening for distress as a clinical responsibility of the system of care, not of the individual physician.

The tools used to clinically assess a patient's distress are a guide for further exploration and rational treatment. As Morgans and Schapira note, there is an overlap in some cancer patients of disease- and treatment-related symptom burden. Depression symptoms such as fatigue, sleep changes, appetite loss, and cognitive effects confound traditional diagnostic methods in the same way personal, cultural, linguistic, and other variables complicate the picture. Under such circumstances, even experienced psycho-oncologists find diagnostic clarity elusive.

“Personality Disorders in the Oncology Setting” provides non-mental health oncology clinicians a vocabulary and clinical concepts to understand and manage “difficult” patients. These patients often prove the “80/20” rule; i.e., “20% of the people drive 80% of my work.” They frustrate, antagonize, and occasionally frighten the clinicians who care for them. The challenge for the authors was to write a review that would not do the same to their readers.