Fast Fact and Concept #007; Depression in Advanced Cancer

2nd Edition

Author(s): Warm, E.; Weissman, D.

Diagnosing and providing treatment for a major depressive episode in patients with a terminal illness can improve quality of life. However, diagnosis of major depression in a terminally ill patient often relies more on the psychological or cognitive symptoms (worthlessness, hopelessness, excessive guilt, and suicidal ideation) than the physical/somatic signs (weight loss, sleep disturbance) described in depression in patients who are not terminally ill. Endicott has proposed substitution criteria:

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

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

Teaching Point: The key indicators of depression in the terminally ill are persistent feelings of hopelessness and worthless and/or suicidal ideation. Note: symptoms of depression overlap findings as patients experience 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.

References

1. Breitbart W et.al, in Oxford Textbook of Palliative Medicine, 2nd ed., Doyle D., ed. 1999, pp 937-944.
2. Endicott J. Measurement of depression patients with cancer. Cancer, 1983;53: 2243-8.
3. Block SD. Assessing and managing depression in the terminally ill. Ann Inter Med 2000;132:209-217.

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Copyright/ Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: . Warm E and Weissman DE. Depression in Advanced Cancer. Fast Facts and Concepts #7; 2nd Edition July, 2005. End-of-Life / Palliative Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in 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.

Creation Date: 2/2000; 2nd Edition July, 2005.

Purpose: Instructional Aid, Teaching

Audience(s)

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): psychosocial and spiritual experience, cancer, psychiatric disorders

Specific Disease and Organ System Category(s): Cancer; Psychiatric Disorders