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Medscape Medical News 2007. © 2007 Medscape

September 19, 2007 — patients with advanced and terminal cancer often experience emotional distress and psychiatric disorders, which can adversely affect quality of life. In a review paper published online September 10 in Cancer, researchers discuss the important role that oncologists can play in screening for these conditions, as well as in helping to reduce psychological distress by effective communication, providing support and first-line treatment, and making appropriate referrals.

Even though data show that emotional distress and psychiatric =isorders are common among advanced cancer patients, oncologists often do not recognize these symptoms in their patients, write Michael Miovic, MD, and Susan Block, MD, both from the Dana Farber Cancer Institute and Brigham and Women’s Hospital, in Boston, Massachusetts.

"Psychiatric disorders are common in cancer patients and are undertreated but usually treatable, and treating them improves quality of life," said Dr. Miovic.

In their article, they point out that less than half of patients receiving palliative care who are also exhibiting symptoms of moderate to severe depression receive antidepressants, even though depression may be more instrumental in moderating the desire for hastened death than the presence of pain.

"Oncologists should be more proactive about screening patients for psychiatric disorders and referring them to individual or group interventions if they show moderate to high levels of emotional distress," Dr. Miovic told Medscape. "But there are no good, systematic data in how many oncology patients are receiving psychiatric or psychosocial treatments."

Data compiled from recent, well-designed studies show that, overall, approximately half of all patients with advanced cancer meet the criteria for a psychiatric disorder, especially when the diagnosis of adjustment disorder is included in the analyses. Adjustment disorders, write the researchers, are the most common psychiatric syndromes that oncologists will encounter in this patient population and are seen in 11% to =5% of cases.

Major depression is also commonly seen in patients with advanced cancer, occurring in 5% to 26% of cases, with the highest rates observed in patients with cancers of the pancreas, oropharynx, and breast. Symptoms of major depression have been associated with a shorter survival time among some cancer patients, and depression is also linked to a reduction in treatment adherence, prolonged hospitalization, and a lower quality of life. In addition, it is estimated that as many as 59% of patients with a terminal illness who desire assisted suicide suffer from depression.

Anxiety is also common, and significant symptoms occur in approximately 25% to 48% of cancer patients, the researchers note. About 2% to =4% of patients with advanced cancer meet the criteria for an anxiety disorder, but subsyndromal posttraumatic stress disorder occurs in 20% to =0% of cancer patients, depending on the methodology used in making the assessment.

Appropriate treatment will largely depend on the symptoms exhibited by the patient and the type of condition. The researchers recommend that oncologists collaborate with mental health specialists for patients who have major mental illness, personality disorders, and problems with substance abuse.

Oncologists can help reduce psychological distress in their patients with advanced cancer in a number of ways, Dr. Miovic pointed out. they need to remember to screen all patients for the presence of mental illness and emotional distress. Learning to differentiate adjustment disorders from depression is important, as is helping patients overcome the stigma that they may feel toward having a psychiatric diagnosis.

"Patients need access to psychiatric care in cancer facilities, is they are generally too overwhelmed and tired to travel to yet another site," he said. "It is also important to have a network of mental health providers who are familiar with oncology patients and their specific needs."

Empathic listening is the most important communication skill that oncologists can use with their patients, as it allows patients to express fears, concerns, hopes, and final wishes, as well as just giving them a chance to be heard, the researchers write. When physicians take time to listen to them, it also shows that they are not too preoccupied, too frightened, or too tired to be present for the patient, and that the patient is valued.

Cancer. Published online September 10, 2007. Abstract

 

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