- Some degree of sadness is to be expected among patients and
among family members caring for a loved one with cancer. This can
come from the many changes that are imposed by the illness and the
unknown future that lies ahead.
- Clinical depression is different from the sadness that most
- It is critical to assess accurately whether the individual is
suffering from clinical depression. Depression is a treatable illness
that can be managed by medication and/or psychotherapy.
- When assessing for depression in people with cancer, it is
important to remember that many of the symptoms of depression can also be symptoms of cancer or cancer treatment.
- There is considerable evidence that a depressive disorder in
the person with cancer can lead to greater distress, decreased
functioning and decreased ability to adhere to medical
- The AHCPR guidelines state that several factors predispose cancer patients to develop depressive disorders. These include: social isolation, recent losses, a tendency to pessimism, socioeconomic pressures, a history of mood disorder, alcohol or substance abuse, previous suicide attempt(s), or poorly controlled pain.
The American Cancer Society states that if five or more of the following symptoms last for two weeks or longer, or are severe enough to interfere with normal functioning, the individual should be evaluated by a qualified mental health professional:
- persistent sad or "empty" mood
- loss of interest or pleasure in ordinary activities
- decreased energy, fatigue, being "slowed down"
- sleep disturbances (insomnia, early waking or oversleeping)
- eating disturbances (loss of appetite or overeating)
- difficulty concentrating, remembering, making decisions
- feelings of guilt, worthlessness, helplessness
- excessive crying
- chronic aches and pains for no apparent reason
- thoughts of death or suicide, suicide attempts
- If depression is suspected, contact a mental health
professional to assess for clinical depression and to determine
whether medication and/or psychotherapy would be appropriate.
- Review medications to assess for depressive side effects
- Instruct the individual to avoid alcoholic beverages, as they
have a depressive effect
- Provide a supportive atmosphere in which the individual feels
comfortable expressing his or her feelings to you. For people who are
experiencing normal sadness, discussions about the meaning of the
illness or a purposeful review of the role that the ill person played
in their relationship may help caregivers identify and clarify their
- Encourage the individual to participate in support groups, or
to contact their priest, minister, or rabbi.
- Encourage prayer or other spiritual support, if this is of
comfort to the individual
- Do not force anyone to talk if they are not ready, however,
reinforce that depression is not a sign of weakness and they should
not be embarrassed to talk about their feelings
- Don't feel that you must cheer the person up in order to be
- Don't feel that expressing or acknowledging feelings will make
the caregiver feel worse. It is important to validate the burden that
these feelings cause.
- Recognize that depression often makes people feel unable to
take action. Therefore, you may recommend a referral or a support
group and find that the caregiver does not follow through with your
recommendation. Try to facilitate follow-through... Arrange for a
third party to provide transportation...encourage the caregiver to
implement a recommendation while you are present in the home.
- Encourage hospice volunteers or other volunteer home visitors
to visit with the caregiver as well as the patient. Frequently,
depression in the caregiver drives other members of the their support
system away. Volunteer visitors play an important role in reducing
the isolation that is caused by and contributes to their depression.
- Remind the individual that treatment of depression may take
weeks to months to notice improvement. It may also recur at some
later date, but having experienced it, the individual will be able to
identify and treat it earlier.
- While suicide is less common than many people think, thoughts and discussion about suicide must be taken seriously. Try to determine if thoughts and discussion about suicide are motivated by uncontrolled symptoms in the patient, such as pain.
Much of the preceding information has been derived from materials from the American Cancer Society, 1599 Clifton Road NE, Atlanta, GA, 30329
1 Agency for Health Care Policy and Research (1993) Depression in Primary Care: Volume 1, Detection and Diagnosis. Clinical Practice Guideline Number 5. US Department of Health and Human Services. AHCPR publication no. 93-0550.