Relations between desire for early death, depressive symptoms and antidepressant prescribing in terminally ill patients with cancer

Abstract

SUMMARYSome patients with advanced cancer express the wish for an early death. This may be associated with depression.We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They completed the Hospital Anxiety and Depression Scale questionnaire and answered four supplementary questions on desire for early death.Only 2 patients expressed a strong wish for death by some form of suicide or euthanasia. 120 denied that they ever wished for early release. The desire for early death correlated with depression scores. Depressive symptoms were common in the whole group but few were on antidepressant therapy.Better recognition and treatment of depression might improve the lives of people with terminal illness and so lessen desire for early death, whether natural or by suicide.

Development of a short form of the Spanish schedule of attitudes toward hastened death in a palliative care population

“…In the last two decades, several instruments have been designed to measure the WTHD and to identify factors related with it [3–6]. The most widely used instrument is the schedule of attitudes toward hastened death (SAHD).…”

Attitudes toward euthanasia among Swedish medical students

“…Among the terminally ill, studies have been conducted that indicate a positive attitude towards euthanasia in general; however, few dying patients express a personal wish for it (20,58,198,220). There are studies showing that cancer patients have an increased wish to die, demonstrated by suicide rates in cancer patients.…”

“…Many studies have demonstrated a correlation between depression, anxiety and WHD (4,119,148,191,220). Several studies also showed that dying cancer patients have an increased incidence of depression, compared with the general population (20,31,119,198,222).…”

Depression and anxiety in palliative care inpatients compared with those receiving palliative care at home

“…Up to 29% of palliative care patients have been identified as experiencing depression or other mood disorders at some time during the palliative phase (Durkin et al, 2003;Lloyd-Williams et al, 2004;Miovic & Block, 2007;Teunissen et al, 2007) and it has been shown with cancer patients in the palliative care stage, that previously mentally healthy individuals become psychologically vulnerable as the disease progresses (Dudgeon et al, 1995;Mazzocato et al, 2000;Akechi et al, 2004). A clinical diagnosis of depression in terminally ill cancer patients has been significantly associated with a desire for hastened death and can have an adverse effect on their quality of life (Breitbart et al, 2000;Tiernan et al, 2002). A recent study showed that among patients in Oregon who requested a physician's aid in dying, one in four had clinical depression (Ganzini et al, 2008) and a Swiss study found that in 114 cases of assisted suicide, 27% had been observed by the assessor to be depressed (Bosshard et al, 2008).…”