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Depression Increases With Advanced Cancer and May Influence Cancer Pain

Depression Increases With Advanced Cancer and May Influence Cancer Pain

NEW YORK--Depression is more common in patients with advanced
cancer and can have an adverse effect on cancer pain. For example,
in patients with advanced breast cancers, a study showed that
concomitant depression and interpretation of pain influenced pain
more than site of disease or presence of metastases, Memorial
Sloan-Kettering psychiatrist William S. Breitbart, MD, said at
a conference sponsored by Cancer Care, Inc., a social work agency
for cancer patients and their families.

The women who interpreted their pain as a progression of their
disease reported more pain than those who had a more benign interpretation,
Dr. Breitbart said. He noted that about half of all cancer patients
will develop a diagnosable psychiatric disorder during the course
of their disease. Adjustment disorder is the most common, making
up about 68% of all psychiatric disorders among cancer patients.
About 15% develop depression, about 10% develop delirium, and
a smaller percentage develop anxiety disorders, Dr. Breitbart
said.

Half of the cancer patients who do not have a psychiatric disorder
are still psychologically distressed. "They're anxious, tense,
worried, and may have problems with sleep," he said.

About 50% of patients with advanced cancer develop depression,
which can contribute to suicidal ideation.

"Some patients, because of symptoms related to their cancer
and treatment, feel a loss of control that induces a sense of
helplessness," Dr. Breitbart noted. "Suicidal ideation
is sometimes a way of trying to control things, but, more often,
it is a signal that someone is not coping and may be seriously
depressed."

Patients who do commit suicide often have a family history of
suicide or have attempted suicide before. They may be patients
who have a protracted terminal phase of their illness.

"We had a number of suicides in our home care program,"
Dr. Breitbart said. "They were patients who took a very long
time to die, 9 months to a year. When the dying process becomes
very prolonged, it's extremely exhausting for patient and caregiver
alike, and it makes people more likely to see suicide as a solution."

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