Palliative and Supportive Care

Review Articles

Depressed patients with incurable cancer: Which depressive symptoms do they experience?

Elisabeth Brennea1a2 c1, Jon Håvard Logea1a3, Stein Kaasaa1a2, Ellen Heitzera4, Anne Kari Knudsena1 and Elisabet Wastesona1a5 On behalf of the European Palliative Care Research Collaborative (EPCRC)

a1 European Palliative Care Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

a2 Cancer Clinic, St. Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway

a3 National Resource Center for Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway and Department of Behavioural Medicine, University of Oslo, Oslo, Norway

a4 Division of Palliative Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria

a5 Division of Psychology, Department of Social Sciences, Mid Sweden University, Campus Östersund, Östersund, Sweden

Abstract

Objective: Diagnosing depressive disorders in palliative care is challenging because of the overlap between some depressive symptoms and cancer-related symptoms, such as loss of appetite and fatigue. In order to improve future assessment of depression in palliative care, depressive symptoms experienced by patients receiving pharmacological treatment for depression were assessed and compared to the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for major depressive disorder.

Method: Thirty Norwegian (n = 20) and Austrian (n = 10) patients with advanced cancer were included. Semistructured interviews on symptom experiences were conducted and transcribed verbatim. By the phenomenographic method, patients' symptom experiences were extracted and sorted by headings, first individually and then across patients. The patients subsequently rated 24 symptoms numerically including the DSM-IV depression criteria.

Results: Lowered mood and a diminished motivational drive were prominent and reflected the two main DSM-IV symptom criteria. A relentless focus on their actual situation, restlessness, disrupted sleep, feelings of worthlessness, feelings of guilt, and thoughts of death as a solution were variably experienced. Appetite and weight changes, fatigue and psychomotor retardation were indistinguishable from cancer symptoms. All these symptoms reflected DSM-IV symptom criteria. Some major symptoms occurred that are not present in the DSM-IV symptom criteria: despair, anxiety, and social withdrawal. The numerical ratings of symptoms were mainly in accordance with the findings from the qualitative analysis.

Significance of results: Despair, anxiety, and social withdrawal are common symptoms in depressed patients with incurable cancer, and, therefore, hypothesized as candidate symptom criteria. Other symptom criteria might need adjustment for improvement of relevance in this group of patients.

(Received July 04 2012)

(Accepted July 07 2012)

Keywords

  • Cancer;
  • Depression;
  • Major Depressive Disorder;
  • Palliative Care;
  • Classification

Correspondence

c1 Address correspondence and reprint requests to: Elisabeth Brenne, Pain and Palliation Research Group, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, 3rd Floor Gastro Centre South N-7006 Trondheim, Norway. E-mail: elisabeth.brenne@ntnu.no