# 007 Depression in Advanced Cancer, 2nd ed


Author(s): Eric Warm MD and David E Weissman MD

Background Diagnosing and providing treatment for a major depressive episode in patients with advanced cancer can improve quality of life. However, diagnosing major depression in an advanced cancer can be complicated by the fact that many cancer symptoms overlap with the somatic symptoms of depression. Clinicians often rely more on the psychological or cognitive symptoms of depression (worthlessness, hopelessness, excessive guilt, and suicidal ideation) than the physical/somatic signs (weight loss, sleep disturbance) when making a diagnosis in advanced cancer patients. Endicott has proposed substituting somatic criteria with affective criteria when evaluating depression in advanced cancer patients:

Physical/somatic symptoms…

  1. Change in appetite/weight
  2. Sleep disturbance
  3. Fatigue, loss of energy
  4. Diminished ability to think or concentrate

…are replaced by psychological symptoms

  1. Tearfulness, depressed appearance
  2. Social withdrawal, decreased talkativeness
  3. Brooding, self-pity, pessimism
  4. Lack of reactivity, blunting

Teaching Point: The key indicators of depression in the terminally ill are persistent feelings of hopelessness and worthless and/or suicidal ideation. Symptoms of depression can overlap with those of anticipatory grief, a normal aspect of the dying process. See Fast Fact # 43 for a complete description of anticipatory grief and how to differentiate from major depression. See Fast Fact #146 on screening for depression in palliative care.


  1. Endicott J. Measurement of depression patients with cancer. Cancer. 1983; 53:2243-8.
  2. Block SD. Assessing and managing depression in the terminally ill. Ann Inter Med. 2000; 132:209-217.

Fast Facts and Concepts are edited by Drew A. Rosielle MD, Palliative Care Center, Medical College of Wisconsin. For more information write to: drosiell@mcw.edu. More information, as well as the complete set of Fast Facts, are available at EPERC: www.eperc.mcw.edu.

Version History: This Fast Fact was originally edited by David E Weissman MD. 2nd Edition published July 2005. Current version re-copy-edited March 2009.

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Warm E, Weissman DE. Depression in Advanced Cancer, 2nd Edition. Fast Facts and Concepts. July 2005; 7. Available at: http://www.eperc.mcw.edu/EPERC/FastFactsIndex/ff_007.htm.

Disclaimer: Fast Facts and Concepts provide educational information. This information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Psychosocial and Spiritual Experience