Navigating Depression in Cancer Care

In a new episode of Oncology on the Go created in collaboration with the American Psychosocial Oncology Society, host Daniel C. McFarland, DO, spoke with Boris Kiselev, MD. Together, they explored the complex intersection of oncology and psychiatry. The conversation challenged the oversimplification of “cancer-related sadness” to provide clinicians with a framework for distinguishing between normative grief and clinical Major Depressive Disorder (MDD).

The conversation focused on:

• The Diagnostic Continuum: Depression exists on a spectrum ranging from normative sadness—encompassing a healthy, waxing-and-waning response to trauma—to pathological MDD.
• Differentiating Grief vs Depression:
• Grief/Normative Sadness: Often occurs in waves, improves over time, and does not typically affect a patient’s functional ability. It is often a response to the loss of one’s “pre-cancer self”.
• Clinical Depression: Marked by anhedonia (loss of pleasure), persistent feelings of guilt or worthlessness, and a fundamental change in identity where the patient no longer “feels like themselves”.
• The “Quantum” Observation Effect: Patients often present differently to oncologists than they do to mental health professionals. In the oncology clinic, patients may unconsciously “shield” their distress to ensure that their treatment plan remains unchanged.
• The Power of the Story: The experts emphasized that the oncologist-patient relationship is therapeutic. Allowing patients to “tell their story” rather than jumping straight to clinical data builds trust with them and uncovers hidden psychological pressure points.

McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY. Kiselev is a consult liaison psychiatrist at Atrium Health Carolinas Medical Center, an assistant professor in the Psycho-oncology Program in the Department of Supportive Oncology at Atrium Health Levine Cancer Institute, and an assistant professor in Internal Medicine.