Depression in cancer patients: diagnostic and therapeutic considerations.

Bruno Trancas, Graça Cardoso, Antonio Luengo, Carlos Vieira, Dóris Reis

Abstract


Oncologic diseases currently have a high prevalence and present as one of the leading causes of death in the western world. Clinical depression and emotional distress are often the outcome of the threat these diseases present to individual existence. Although its precise determination is hampered by methodological problems, up to 50% of cancer patients may become clinically depressed and experience intense personal distress. We performed a literature review on screening and evaluating clinical depression in cancer patients (risk factors, instruments and strategies) and its treatment (psychotherapy, drug treatment and care management).Non-systematic literature review. The search was performed on Pubmed with the following keywords in title/abstract fields: cancer, oncology, depression, psychiatry, morbidity, screening, treatment, psychotherapy, psychiatric status rating scales, with no time restriction. Articles written in Portuguese, English and Castilian were included. A cross-reference search yielded additional included articles.Several risk factors for an increased likelihood of clinical depression in oncologic diseases have been identified which, together with screening strategies, including validated scales such as Hospital Anxiety and Depression Scale (HADS), may enhance our ability to detect cases. While not having, for the moment, the highest possible evidence for effectiveness from randomized trials, the treatment strategies for clinical depression in this population should be available and make use of multidisciplinary interventions, including psychopharmacological and psychotherapeutic options. The need for health care workers to spend adequate time with patients is underscored. This not only enhances their ability to detect and treat depression cases but also allows for an empathic and understanding relationship, validating the existence and suffering of the patient.

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