Advanced cancer is associated with numerous challenges including progressive physical deterioration that triggers fears regarding dependence and loss of autonomy, mortality and meaning of life. The continuous increase in survival in oncology patients has led them to live in a process of adaptation and continuous changes, which carries a great emotional burden for both the patient and his or her family. Many terminal cancer patients meet criteria for a psychiatric diagnosis or sign distress, with depressive symptoms being very frequent. This makes us think of the imperative need for appropriate interventions for people in this situation, where existential issues, restructuring of purpose, interpersonal relationships, meaning of life and the process of dying and death play a fundamental role. The aim of this work is to describe a Canadian experience of a brief individual psychological therapy called Managing Cancer and Living Meaningfully (CALM), which was developed and evaluated over the last 10 years in Toronto. CALM Therapy was designed to reduce distress and promote psychological well-being in patients with advanced cancer; this article will describe its main components, characteristics and evidence of its benefit for this population.

Present a clinical case of hypomanic outbreak in a patient with ovarian cancer using corticosteroids and to carry out a review of the literature on the subject. Clinical case: Patient with an advanced ovarian cancer, treated with surgery and chemotherapy, debuts with episodes of vomiting that are managed with dexamethasone. During the treatment he presented insomnia, verbiage and grandiosity, diagnosing a hypomanic outbreak secondary to steroidal treatment. Discussion: In cancer patients, and independently of the use of corticosteroids, approximately 50% of them will present some type psychiatric disorder. With corticosteroids the incidence can increase up to 65%-75%. Hypomania accounts for almost 50% of psychiatric disorders induced by corticosteroids. With doses lower than 40 mg/day only 2% of patients will be affected by this type of disorders, while with doses between 40 to 80 mg/day this incidence increases up to 5%. Conclusion: Corticosteroids are widely used in cancer patients, however their use can cause psychiatric disorders. It is important to make the healthcare team more aware of the association of corticosteroids and psychiatric symptoms for rapid detection and clinical management.