A substantial number of patients with metastatic cancer may suffer from depression which tends to persist and grow more severe toward the end of life, according to the results of a study published early online in the Journal of Clinical Oncology.
While cancer and other serious illnesses are risk factors for depression, little research has been performed to evaluate the severity and duration of depression among patients with advanced cancer. In an effort to establish the risk factors and progression of depressive symptoms in this group, researchers from Canada conducted a study among 365 patients with metastatic gastrointestinal or lung cancer.
At the beginning of the study, patients were evaluated in terms of physical distress, self-esteem, attachment security, spiritual wellbeing, social support, hopelessness, and depression. Then, at two-month intervals, patients were reevaluated in terms of physical distress, social support, hopelessness, and depression.
Thirty-five percent of patients reported at least mild depressive symptoms and 16% experienced moderate to severe depression. This depression persisted in up to one-third of subjects. Moderate to severe depression was three times more common in the final three months of life than it was at least one year prior to death.
Risk factors for depression included younger age; pre-existing antidepressant use; lower self-esteem and spiritual wellbeing; and a higher degree of attachment anxiety, hopelessness, and physical burden of illness. The researchers commented that “the combination of greater physical suffering and psychosocial vulnerability put individuals at greatest risk for depression.”
The researchers concluded that depression is relatively common among patients with advanced cancer and grows stronger with closer proximity to death. They recommend an integrated approach that addresses the emotional and physical distress in this patient population.
 Lo C, Zimmermann C, Rydall A, et al. Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. Journal of Clinical Oncology. Published early online: May 17, 2010.
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