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Psychiatric Issues in Cancer
Kiran K-K Taylor and Michelle B Riba
1. Adjunct Clinical Lecturer, Department of Psychiatry, and Clinical Director, PsychOncology Program; 2. Associate Chair for Integrated Medicine and
Psychiatric Services, Department of Psychiatry, and Executive Director, PsychOncology Program, University of Michigan Comprehensive Cancer Center
A new cancer diagnosis or recurrence can result in various levels of depression or anxiety for adult and child cancer patients and their families.
The distress can arise from a multitude of factors: the diagnosis itself; potential or perceived disruptions to quality of life, including family, work,
school, finances and relationships; responses from the social support system, including miscommunication or too little or too much
information; direct or side effects from treatments, either primary or adjuvant; direct or indirect results of the cancer itself; current or past
psychiatric history; etc. Since patients also often have cancer-related pain, fatigue and symptoms from the cancer or its treatment that can
mimic or look very much like depression and anxiety, the challenges for diagnosis and treatment are great. How do we increase awareness
about the importance of recognising depression and anxiety? How do we determine the best ways to screen for distress and then provide
treatments for these symptoms when they occur? How do we provide interventions for various types and stages of cancer and patients of
different genders, ages, cultural backgrounds and past psychiatric histories? This article will address some of these very complex issues.
Psycho-oncology, cancer, depression, anxiety, psychiatry
Disclosure: The authors have no conflicts of interest to declare.
Received: 29 September 2008 Accepted: 3 November 2008
Correspondence: Michelle Riba, Room F6236, University of Michigan Comprehensive Cancer Center, Box 0295, 1500 E Medical Center Drive, Ann Arbor, MI 48109-0295, US.
Cancer is a leading cause of death worldwide: it accounted for 7.9 many aetiologies in patients with cancer. They may come from acute
million deaths (around 13% of all deaths) in 2007. Deaths from cancer medical complications, psychiatric exacerbation or poorly controlled
worldwide are projected to continue rising, with an estimated 12 chronic symptoms such as pain and fatigue. Finally, delirium has an
million deaths in 2030.
Patients with cancer have a high rate of increased incidence in cancer inpatients, particularly haematopoietic
psychiatric co-morbidity: approximately 50% of patients with stem cell transplant recipients, hospice/palliative care patients and
advanced cancer meet criteria for psychiatric disorders. The most patients with advanced cancer. Discerning the aetiology of delirium can
common are adjustment disorders (11–35%), major depression also be difficult because of the overlap between medical and psychiatric
(5–26%), anxiety (15–25%) and delirium (15–75%).
Rates of these symptoms and causes. Rapid identification of delirium is important
illnesses in cancer patients are up to four times higher than in the because it is an acute state and most of the causes are reversible. Some
Prevalence rates of mental illness in cancer of the most common medical causes of delirium in the cancer
appear to increase as patients become sicker.
population include the use of medications such as corticosteroids,
biological response modifiers and various chemotherapeutic agents.
Adjustment disorder is generally considered to be the most prevalent
psychiatric problem associated with cancer.
The diagnosis of With such a significant portion of the cancer population affected by
adjustment disorder is based on a relative change in a patient’s ability to various psychiatric issues, much research and effort has gone into
function rather than on precise symptoms. Identification of adjustment exploring how to improve quality of life with this co-morbidity.
disorder is important because early psychiatric intervention can Current topics that are being explored on a global level in the field of
maximise quality of life and minimise further co-morbid decline. psycho-oncology – the interface between psychiatry and oncology –
Depression is a common yet serious, costly, debilitating and deadly include exploring the effects of mental illness on patient function,
co-morbidity in cancer patients. Depressive disorders worsen over the physician/provider communication, screening for mental illness in
course of cancer treatment, persist long after cancer therapy, reoccur the oncological environment, care-giver burden and creative or
with the recurrence of cancer and have a significant impact on health complementary therapies for patients with cancer and distress.
outcomes such as mortality, quality of life and treatment adherence.
Rates of depression appear to be higher among patients who have Co-morbidity and Stress and the
greater disability and pain and more advanced disease.
Anxiety in Impact on Patient Functioning
cancer is more prevalent in women and patients between 50 and 65 Evidence emerging from the science of psychoneuroimmunology is
years of age.
The predominately somatic symptoms of anxiety can have beginning to show how psychosocial stressors interfere with the
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