Friday, April 3, 2009

'I'd be depressed too'

Tom recently posted on another major publication from the Coping With Cancer Study. Psycho-Oncology, a couple months back, also published a CWC analysis that I overlooked until recently - looking into whether rates of psychological illness increase as cancer patients approach death.

(See prior posts for descriptions of how the CWCS was done). In this analysis of ~280 patients, they compared baseline assessments (of, among other thing, psychiatric symptoms) across groups of patients by time to death (groups were divided into months to death from the initial assessment, ie: 1-2-3-4-5-6-6+ months). This way, for instance, psychiatric morbidity could be compared between those patients who ended up dying within a couple months to those who lived 6 or more. This analysis is cross-sectional: patients weren't followed from the initial assessment with repeated assessments until death to see if mental illness/symptoms increased - instead those who 'happened' to die rapidly were compared with those who didn't.

They found that rates of mental illness (major depression, PTSD, generalized anxiety disorder, panic disorder) were ~10% across all groups, regardless of time-to-death. Existential distress did seem to be increased in those closer to death, along with physical symptoms; but not actual rates of psychiatric illness. They suggest that it is perhaps physical limitations and symptoms which cause the existential distress, although curiously not 'diagnosable' psychiatric illness.

This is good news overall of course, and should lead further support to the idea that depression is not 'normal' in (even advanced) cancer - and should not be accepted as such (as normal and therefore not worthy of intervention). Concluding 'Well I'd be depressed too if this was happening to me' is just wrong: you'd likely have episodes of sadness, grief, loss, longing but not a pervasive disturbance of mood and thought.

Psycho-Oncology also has a review on existential concerns in cancer patients. It's a quick summary of the scope and nature of the research about this; not particularly practical/clinically oriented but an excellent summary/starting point for those interesting in the research (good one for the teaching file, particularly for fellows).

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