Depression in Cancer Patients: Recognition and Treatment

Steven D. Passik, PhD, Margaret V. McDonald, MSW, William M. Dugan, Jr., MD, Sara Edgerton, MS, Andrew J. Roth, MD


Medscape Psychiatry & Mental Health eJournal. 1997;2(3) 

In This Article

Prevalence of Depression in Cancer Patients

Every individual, whether healthy or ill, will experience periods of sadness or depression in his or her lifetime. In order to consider the prevalence of depression in the context of the general population, it should be recognized that in a National Institute of Mental Health study of over 1000 people at-large, the prevalence of depression was reported to be 6%.[17] Studies have reported that women and older persons in the general population have an increased rate of depression.[18,19]

Studies have also reported a wide range of prevalence of depression in cancer patients, and this variation reflects differing assessment tools, techniques, and populations (ie, disease site and stage). Lansky and colleagues[2] surveyed ambulatory patients with gynecologic cancer and found a 5% rate of depression. Dugan and colleagues[20] recorded clinically significant depressive symptoms at a prevalence of 35.9% in a large group (N=1109) of ambulatory patients with varied sites and stages of disease. A study by Craig and Abeloff[3] reported an overall prevalence of 53% for hospitalized cancer patients with varying primary sites and stages. Overall, it is estimated that 25% of cancer patients have clinically significant depressive symptoms or major depression.[4,21,22] In the general population, there is a preponderance of depressive symptoms reported by females; in the cancer population, however, there is no such finding.[23]

Table I presents factors known to influence the risk of depression in cancer patients.[24] Four broad categories are listed: cancer-related factors, cancer treatment-related factors, psychiatric history, and social factors. Cancer patients with advanced disease are a particularly vulnerable group. Bukberg and associates[6] indicated that among hospitalized, bed-restricted patients, the rate of depression was as high as 77%. Pain, depression, and delirium all increase along with rising levels of physical debilitation and advanced illness.[25,26] Certain types of cancer are also associated with an increased occurrence of depression. For instance, depression and anxiety occur more frequently in patients with pancreatic cancer than in patients with other forms of cancer.[8,9,27] Lung cancer patients also seem to have particularly high rates of psychological distress.[10] An individual's coping ability, social support, and personality also play a role in the level of psychological distress that he or she typically experiences.