5 Fast Facts for Addressing Distress & Depression in Cancer
Despite advances in clinical care for patients with cancer, distress and depression continue to haunt patients. These fast facts will help you better understand and care for patients with cancer.
Despite advances in clinical care for patients with cancer, distress and depression continue to haunt patients. These fast facts will help you better understand and care for patients with cancer.
Rates of distress can vary based on age, gender, race, cancer site, and stage of disease.
A recent study showed that the odds of being depressed among cancer patients was five times higher than in the general population.
Source: Hartung TJ, Brähler E, Faller H, et al. The risk of being depressed is significantly higher in cancer patients than in the general population: prevalence and severity of depressive symptoms across major cancer types. Eur J Cancer. 2017;72:46-53.
Rates of depression in patients with cancer vary widely in the literature, with rates of depression and depressive disorders as low as 5% and as high as 60%. The variability has been attributed to different diagnostic criteria for depression, diverse instruments/tools to identify depression, as well as the inclusion of different cancer types, stages of disease, and phases of treatment.
Source: Caruso R, Nanni MG, Riba M, et al. Depressive spectrum disorders in cancer: prevalence, risk factors and screening for depression: a critical review. Acta Oncol. 2017;56:146-155.
Treatment should not only address depressive symptoms but also any medical, disease-related and/or psychosocial factors contributing to symptoms. the National Comprehensive Cancer Network (NCCN) has identified Clinical Practice Guidelines (v3.2019) for managing symptoms across the continuum of distress. They emphasize a multidisciplinary approach and the use of psychosocial interventions, pharmacologic therapies, and certain practices associated with complementary and/or integrative medicine for distress and depression.
Because of the lack of evidence to support one modality over another, selection of type of psychotherapy is recommended to be based on patient factors and available resources.
Antidepressants utilized in patients with cancer are similar to those used in regular clinical practice; selective serotonin reuptake inhibitors/selective serotonin-norepinephrine reuptake inhibitors are often first line as they are well-tolerated and safe. Other antidepressants commonly utilized include mirtazapine, bupropion, tricyclic antidepressants, and psychostimulants.
A systematic review by the Society of Integrative Oncology, which looked at the effect of a number of varied complementary therapies in patients with breast cancer during and after cancer treatment, demonstrated evidence in support of: meditation, relaxation, yoga, massage, and music therapy for depression/mood disorders; music therapy, meditation, stress management, and yoga for anxiety/stress reduction; and meditation and yoga to improve quality of life.
Source: Greenlee H, DuPont-Reyes MJ, Balneaves LG, et al. Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. 2017;67:194-232.
For more on this topic, see Reducing Distress and Depression, by Jessica R. Molinaro, MD, and Jennifer M. Knight MD, MS, on which this slideshow is based.