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Depression Common at End of Terminal Cancer

Study urges integrated care to give terminally ill patients both physical and emotional support

THURSDAY, May 20 (HealthDay News) -- Depression is a common condition among patients with metastatic cancer, and those with a combination of psychosocial vulnerability and greater physical suffering are at the highest risk, according to a study in the Journal of Clinical Oncology.

Christopher Lo, of the University of Toronto, and colleagues followed 365 patients with metastatic gastrointestinal or lung cancer to determine the predictors and course of depression in terminally ill patients. Through questionnaires, the researchers ascertained baseline levels of depression, physical distress, spiritual well-being, social support, self-esteem, attachment security, and feelings of hopelessness, then reassessed the patients at two-month intervals.

Overall, 35 percent of the patients reported instances of at least mild depressive symptoms, with 16 percent reporting moderate-to-severe depressive symptoms, which persisted in a third of cases. Depressive symptoms that were moderate to severe were almost three times more common in the three months before death than at one year or more before death. Predictors of depression were younger age, baseline antidepressant use, low self-esteem, low spiritual well-being, greater attachment anxiety, hopelessness, physical burden of illness, and proximity to death. Individuals with a combination of greater physical suffering and psychosocial vulnerability had the highest risk for depression.

"These findings are consistent with the view of depression as a final common pathway of distress, resulting from the effects of multiple, interacting biologic and psychosocial risk factors. They also support the need to evaluate preventive and therapeutic interventions, particularly for individuals with multiple risk factors for distress, and to consider integrated and palliative interventions to address the interrelated problems of emotional and physical suffering in this population," the authors write.

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