Depression in palliative care patients - a prospective study

Abstract

Psychological and psychiatric morbidity can be a major source of distress to terminally ill patients and their relatives and friends. A prospective study was carried out to determine the prevalence of undiagnosed depression in palliative care patients and to determine whether factors such as age, previous psychiatric history and perceived social support have any association with the development of depression when patients have advanced metastatic cancer. Patients aged between 18 and 70 years who had a prognosis of < or = 6 months and who were receiving palliative care only for advanced metastatic cancer were interviewed using the Present State examination interview and a semi-structured interview to determine social support, information needs and past psychiatric history. One hundred patients were recruited and the prevalence of depression according to International Classification of Diseases 10 criteria was 22%. Perceived informal social support and past psychiatric history were not associated with being a case of depression but perceived information needs had a weak association. Younger patients and patients with breast cancer were more likely to be identified as being cases of depression. Further research is necessary to explore the aetiology and outcome of depression in palliative care. A high index of suspicion for depression should be maintained for younger patients with advanced metastatic cancer.

Depression in advanced cancer – Assessment challenges and associations with disease load

“…To reduce the problem of symptom-overlap, the DSM-5 states that symptoms due to a general medical condition should be ignored (APA, 2013). Correctly attributing symptoms to the cancer or to the depression can, however, be particularly challenging in multi-symptomatic advanced cancer patients in the context of a busy clinical setting (Chochinov, 2001;Lloyd-Williams and Friedman, 2001).…”

Palliative Medicine Practitioners' Views on the Concept of Depression in the Palliative Care Setting

“…epression is widely acknowledged to be an important clinical issue in palliative care, with an estimated prevalence of 5%-26% [1][2][3][4] and association with adverse outcomes such as high symptom burden, 5 spiritual distress, 6 poor performance status, 7 shorter survival, 8 longer length of hospice stay, 9 and desire for hastened death. 7,10 Nevertheless, depression remains an ambiguous concept.…”

O conhecimento do diagnóstico de câncer não leva à depressão em pacientes sob cuidados paliativos

“…Breitbart et al demonstraram que, em pacientes com câncer em estágio terminal internados, havia 16% de depressão grave, e em nosso estudo esse valor foi de 9,68% 21 . Um dos fatores, conforme descrito por Lloyd et al é o momento em que se avalia a depressão nestes pacientes que pode interferir nos resultados, pois em seu estudo a prevalência de depressão foi tanto maior quanto mais próximos do fim da vida estavam os pacientes 22 . Com relação ao fato de não ter recebido nenhum tratamento oncológico estar relacionado com depressão, Navari et al mostraram que muitos pacientes com câncer avançado querem ser tratados mesmo que a chance de prolongar a vida seja pequena 23 .…”