Depression in Patients with Advanced Cancer

Abstract

Prevalence and risk factors for depression, desire for death, and diagnosing depression were examined in patients with advanced cancer. 1) Of 141 subjects, 44 patients diagnosed with recurrent breast cancer and 97 with advanced non-small-cell lung cancer, 43.2% of those with recurrent breast cancer and 14.4% of those with advanced non-small-cell lung cancer met the DSM-III-R criteria for adjustment disorder or major depression. Logistic regression analysis showed that a disease-free interval less than 24 months in recurrent breast cancer and low fighting spirit, family history of cancer death, past history of depression and dissatisfaction with confidants in non-small-cell lung cancer significantly predicted a diagnosis of adjustment disorder or major depression. These results indicate that psychosocial interventions are necessary for patients with advanced cancer who have risk factors for depression. 2) All of 5 patients with terminal cancer who expressed a desire for death were diagnosed with major depression according to DSM-III-R. After treatment with tricyclic antidepressants, they all showed remarkable improvement of depressed mood and their desire for death had almost disappeared. These experiences suggest that appropriate treatment of depression may alter the desire for death in terminally ill cancer patients. However, depression is frequently underdiagnosed and undertreated because the diagnostic criteria of major depression include physical symptoms normally observed during the course of cancer and/or cancer treatment. We propose using a biological marker (serotonin2A receptor-mediated Ca2+ response in human platelets) as one of the adjuncts in diagnosing depression in cancer patients.