Care needed for terminal cancer patients' distress

People dying of cancer often suffer depression and other forms of emotional distress, but early treatment might be able to lessen these symptoms, according to Japanese researchers.

Their study of 209 terminally ill cancer patients found that about one quarter had major depression or an adjustment disorder, including moderate forms of anxiety or depression, at some point toward the end of their lives.

But these psychological symptoms weren't static. As the researchers followed the patients, about 31 percent developed a new major depressive episode or an adjustment disorder, or experienced an improvement in existing symptoms.

A predictor of new symptoms was patients' self-reports of feeling down or anxious at the start of the study. This, the authors say, suggests that intervening early to ease such "subclinical" depression and anxiety could keep symptoms from worsening.

"The findings suggest that even when anxiety and depression are on a subclinical level, they should be managed intensively to prevent subsequent psychological distress," the study's lead author, Dr. Tatsuo Akechi, told Reuters Health.

Akechi, who is from Nagoya City University Medical School in Japan, and colleagues report the findings in the Journal of Clinical Oncology.

For the study, the researchers interviewed cancer patients at the time they registered for palliative care, a form of medical care that focuses on making patients comfortable at the end of their lives. The patients were interviewed again when they were admitted for in-patient palliative care, which was typically about two months later.

At the outset, 16 percent of patients were diagnosed with an adjustment disorder, and about 7 percent with major depression. By the second interview, those numbers were 11 percent and 12 percent, respectively.

The fact that about 30 percent of patients had a change in their psychiatric diagnosis during this short time suggests that "continuous, close, and intensive monitoring of psychological distress is required in terminally ill cancer patients," the researchers write.

They also point out that the rate of psychological distress among these Japanese patients was lower than research suggests is the norm; a recent research review indicated that at least 30 percent of people dying of cancer develop clinical depression or an adjustment disorder. Cultural factors, such as the tradition of strong family ties in Japan, may help explain the difference, the authors note.

Regardless of such differences, the findings are relevant across cultures, according to Akechi.

SOURCE: Journal of Clinical Oncology, May 15, 2004.