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."