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Cancer Resources > Cancer News > 2007 > September

Psychiatric disorders common among advanced cancer patients

Will Boggs, MD

Last Updated: 2007-09-17 17:07:18 -0400 (Reuters Health)

NEW YORK (Reuters Health) - As many as 50% of patients with advanced cancer meet criteria for a psychiatric disorder, according to a report in the September 10th online publication of Cancer.

"Psychiatric conditions are highly prevalent in patients with advanced cancer, are usually treatable, and treating them improves quality of life," Dr. Michael Miovic from the Dana Farber Cancer Institute, Boston, Massachusetts told Reuters Health. "Oncologists should screen for common syndromes of anxiety and/or depression, initiate first-line treatments, and make appropriate referrals to mental health professionals for further evaluation and psychotherapy."

Dr. Miovic and Dr. Susan Block reviewed the literature on common psychiatric disorders in advanced cancer and approaches to these conditions.

Adjustment disorders represent the most common psychiatric condition in advanced cancer patients, the authors report. These disorders include symptoms of situational anxiety or depression that are distressing enough to warrant treatment but not so strong and pervasive as to meet criteria for a diagnosis of anxiety or depression.

Major depression is the next most common affliction, the report indicates, and it is especially common among patients with cancers of the pancreas, oropharynx, and breast.

Both psychosocial and pharmacological treatments are effective for anxiety and depression, the investigators say, although clinical studies investigating these treatments are scarce.

"Diagnosing major depression and initiating appropriate treatments, including medications and referral to psychotherapy (individual and/or group), and referring to psychiatric evaluation if the patient does not respond to these standard first-line treatments" should be top priorities for the oncologist, Dr. Miovic said.

"Starting first-line medications for symptom control is also very important to improving quality of life in patients with advanced disease, including prescribing stimulants for fatigue, hypnotics for insomnia, various anti-anxiety agents for anxiety (SSRIs and/or benzodiazepines), and antipsychotics for nausea or delirium," he continued.

"Data indicate that about 90% of patients with advanced cancer are willing to receive treatment for emotional problems, but that in this population, 55% of patients with a psychiatric diagnosis do not access mental health services," Dr. Miovic added. "Thus, patients are clearly not receiving the treatment they want, need, and deserve."

Cancer 2007;110.

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