Terminal cancer care should do more to treat depression
Wednesday, 4 March 2015 00:00
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Reuters: Depression could be clouding the last 24 hours of life for a significant number of people with advanced cancer, pointing to a need for better – and earlier – psychological help, according to a large study in The Netherlands.
Although it’s challenging to tease apart depression symptoms from the pain, fatigue and cognitive problems associated with end-stage cancer, more can be done to alleviate depression and anxiety, researchers said.
“Health care providers may think this is a normal part of the dying process,” said lead author Dr. Elene Janberidze from the European Palliative Care Research Center at the Norwegian University of Science and Technology in Trondheim.
“However, some patients experiencing depressive symptoms and/or depression can be treated and thus both the patients and their families may have a better quality of life,” Janberidze told Reuters Health in an email. Previous studies have estimated the rates of depression in patients with advanced cancer at anywhere from 2% to 56%, she and her colleagues write in the journal BMJ Supportive and Palliative Care.
Janberidze said that her team chose to focus on patients in their last 24 hours of life because this group had not been well investigated.
They used data from a 2005 nationwide Dutch survey of doctors who had signed the death certificates of patients that died within the past two months. The researchers examined data on 1,363 cancer patients during their last 24 hours of life, assessing the symptoms reported by their attending physicians and rating their level of depression.
After accounting for symptoms of the individuals’ illness, the researchers found that overall 37% of patients were depressed. More women than men were severely or very severely depressed, and patients aged 17 to 65 were more likely to be moderately depressed than those 80 years or older.
Geriatricians were four times more likely than other doctors to assess their patients as seriously or severely depressed. Pain specialists, palliative care consultants, psychiatrists and psychologists were also more often tending to patients with symptoms of serious depression than to those with mild or moderate depression.
Mild or moderately depressed patients were more likely to feel tired, anxious and confused than those without depression symptoms. Individuals who were severely or very severely depressed also tended to feel anxious.
Holly Prigerson, who directs the Center for Research on End-of-Life Care at Cornell University, said she admired the authors for trying to gauge depression in cancer patients who were so close to death.
