Depression in cancer patients: Pathogenesis, implications and treatment (Review)

Abstract

Depression is a common comorbidity in cancer cases, affecting >10% of patients. A cancer diagnosis is life-changing, and is a source of considerable psychological and emotional stress. Non-pathological sadness may be a normal response to a cancer diagnosis, however, stress beyond the coping mechanisms of patients may result in major depressive disorder. The current review, in addition to the obvious psychosocial elements of depression, explores its biological mechanisms, including tissue damage, inflammatory mediators and the chronic stress response, and how these immune and endocrine pathways may underlie depression in cancer. Possible iatrogenic causes of depression in cancer are also explored. There is a strong need to identify and treat depression in cancer patients in order to increase quality of life and reduce mortality. The most popular clinical and potential future biochemical screening tools for depression in cancer are briefly discussed. The interventions used will vary for every patient, but may include psychosocial therapies or pharmacotherapy; however, a paucity of research on the most effective management of depression in cancer means the optimal combination of therapies is unknown. Selection of antidepressants should be carefully considered, given the common side effects of chemotherapy (such as nausea), and the necessity to avoid serious interactions, including reducing the effectiveness of chemotherapeutic drugs. The possible link between the chronic stress response, which may predispose patients to depression, and the risk of mortality from cancer is also explored. The complex interactions between the endocrine, nervous and immune systems, which continue to be elucidated, may offer the opportunity for the development of more rapid and efficacious treatments for depression in cancer in the future.

Depression and anxiety in patients with cancer

“…These figures greatly exceed population estimates of past-year depression (5%) and anxiety (7%) 8. Two thirds of patients with cancer and depression also have clinically significant anxiety symptoms 3. Figures vary by cancer type, with major depression affecting an estimated 13% of patients with lung cancer, 11% of those with gynaecological cancers, 9% in breast cancer, 7% in colorectal cancer, and 6% in genitourinary cancers 9.…”

“…Psychiatric illnesses such as depression and anxiety are common, but often neglected, complications of cancer, influencing quality of life, adherence to treatment, cancer survival, and treatment costs 23. Depression and anxiety affect up to 20% and 10% of patients with cancer respectively, regardless of the point in the cancer trajectory, and whether in curative or palliative treatment 4.…”

Impact of an exercise programme on sustaining physical activity for recovering cancer patients: A qualitative study.

“…Ideally, medical interventions required to treat cancer would extend beyond dealing with the physical affects of disease, to include a range of measures that attend to the whole person and thus financial [6], psychological [7] and social domains [8]. Evidence has shown exercise to be safe and effective with various cancer types that enable wide reaching benefits for the recovery of patients both before, during and after treatment [9,10].…”

Exploring low mood in a person with cancer

“…Check that depressive symptoms are not a result of the biologically mediated effects of the tumour or treatment (see infographic) 1. For example, weight loss, low energy, and poor motivation may be a consequence of cancer cachexia or chemotherapy.…”

“…Depression and anxiety are more common in patients with cancer, and they are associated with poorer quality of life and cancer survival 12. This article offers advice on how to recognise these disorders, and when to offer referral for specialist advice.…”