Depression in cancer patients
Depression in cancer patients is a symptomatic depressive disorder caused by experiencing a serious illness, neurohumoral changes caused by tumor growth or the negative effects of oncotherapy. The main symptoms are tearfulness, insomnia, decreased appetite, fatigue, irritability, anxiety, social isolation, a feeling of helplessness, uselessness, hopelessness. The diagnosis is established on the basis of observation data, clinical conversation and psychological testing. Medications and psychotherapy are used for treatment.
The problem of depression in oncology has been actively investigated over the past decades. An inverse correlation has been established between the severity of this disorder and the survival rate of patients. The prevalence of depression is determined by the localization of the tumor: pancreas, adrenal glands, brain – up to 50%, mammary glands – 13-23%, female genitals – 23%, large intestine – 13-25%, stomach – 11%, oropharynx – 22-40%. The high–risk group includes young people, patients undergoing palliative care, and patients with a history of affective disorders. Comprehensive medical and psychological assistance to depressed patients improves the effectiveness of basic therapy.
Reasons
Depression in cancer can have predominantly neurotic or somatogenic origin. It is quite difficult to establish the exact reasons, since the emotional state of the patient is the result of his perception of the disease, biochemical shifts caused by the development of a neoplasm, the use of radiation and chemotherapy. Factors contributing to depression can be grouped as follows:
Psychological. The news of the disease becomes a traumatic event. Depression is formed due to the deterioration of the quality of life – pain, debilitating medical procedures, hospital stay, uncertainty of the future, the risk of death.
Physiological. Tumors located in the endocrine glands and nervous tissue alter neurohumoral regulation, this is manifested by emotional and behavioral disorders. Neoplasm cells of any localization secrete toxic substances that negatively affect the functioning of the nervous system.
Therapeutic. Prolonged deterioration of well-being when using chemo and radiation therapy – nausea, vomiting, weakness, inability to concentrate, conduct a conversation, perform everyday tasks – provokes depression. When using some drugs, it is a possible side effect.
Pathogenesis
In cancer patients, depression appears as a result of psychotrauma, prolonged stress, neuroendocrine disorders. After the cancer diagnosis is confirmed, a stage of resistance occurs – patients refuse to believe doctors, become irritable, angry, and require additional examinations. Then a phase of depression is inevitable – information about the disease is accepted, prospects are assessed pessimistically regardless of the real prognosis. At the physiological level, the exchange of biogenic amines (neurotransmitters) – serotonin, norepinephrine and gamma-aminobutyric acid is disrupted. The speed and direction of pulse transmission changes, which is manifested by a decrease in mood and performance. Another mechanism for the development of depression is an increase in the activity of the hypothalamic–adrenal-adrenal axis caused by the development of a tumor in the endocrine glands or the brain, the presence of pain syndrome, cancer intoxication.
Symptoms of depression in cancer patients
Patients are in a depressed mood, experiencing fatigue, depression. They become non-contact, the questions of doctors and relatives are answered monotonously, in monosyllables. Communication even with the closest people is burdensome. Patients find excuses to stop the conversation – fatigue, poor health, the need to sleep, go for procedures. In severe depression, communication is completely absent, patients turn away from their interlocutors, silently go to another room. Depression has a bad effect on the effectiveness of the main treatment, slows down the recovery process. Patients refuse procedures, ask to postpone them indefinitely, citing fatigue, the need for rest, the need to go to another city on business. They do not follow the regimen recommended by the doctor, do not take food, talk about lack of appetite.
Speech and thought processes are slowed down. Severe depression is manifested by apathy, unwillingness to get out of bed, lack of interest in the surroundings and previously fascinating activities. Patients do not go out for walks, do not read books. They can look at the TV screen or out the window for days on end, but they do not perceive what is happening, they do not remember. Any movements are performed through force, they need outside help to perform medical and hygienic procedures, eating. Sometimes they refuse to wash, shave, change clothes. The state of depression makes it much more difficult to conduct a clinical survey, patients poorly describe how they feel, tend to confirm or refute all the assumptions of the doctor (everything hurts, it hurts everywhere).
Complications
Depressive state in oncological pathology can lead to suicidal behavior. The high-risk group for suicide includes patients with late-stage cancer, when hope for recovery is lost, and death is perceived as an inevitable event. Other factors that increase the likelihood of suicide are severe pain that cannot be corrected by medication, nervous exhaustion, fatigue, ineffectiveness of basic therapy, unfavorable medical prognosis, acute disorder of consciousness, lack of behavior control.
Diagnostics
Identifying depression in patients with oncopathology is the task of a psychiatrist. Patients themselves rarely seek help, the examination is carried out on the initiative of relatives or the attending physician. Diagnostics is aimed at detecting characteristic symptoms, assessing the severity of emotional disorder, determining the risk of suicidal behavior. The following methods are used:
Clinical conversation. A survey of the patient and relatives is being conducted. The main complaints are depressed mood, tearfulness, apathy, refusal of food, therapeutic measures. The patient reluctantly supports the conversation, answers in monosyllables.
Observation. The psychiatrist evaluates the characteristics of the behavior, emotional reactions of the patient. Characterized by slowness, lethargy, lack of motivation for the examination.
Psychodiagnostics. Due to the rapid fatigue and exhaustion of patients, express methods are used: the Beck depression questionnaire, the Depression questionnaire (ODS) and others. Additionally, a color selection test (Lusher test), a drawing of a person is carried out.
Treatment of depression in cancer patients
Assistance to cancer patients with depression is aimed at relieving symptoms, the key of which is apathy, as well as restoring social activity, changing attitudes to the disease, to the future. Treatment and rehabilitation are carried out by the efforts of a psychiatrist, psychotherapist, relatives. An integrated approach includes:
Individual psychotherapy. Sessions are conducted in the form of a confidential conversation. Techniques of cognitive and existential psychotherapy are used, the purpose of which is to bring the patient to comprehend the disease, its impact on life, to realize basic values, to take responsibility for his condition.
Visiting support groups. Communication with other patients helps to overcome despair, loneliness and alienation. The elimination of depression is facilitated by an open discussion of the difficulties associated with the disease and the treatment process, receiving emotional support, sharing experience in overcoming the crisis.
The use of medicines. The treatment regimen is determined by a psychiatrist individually, taking into account the chemotherapeutic drugs used, the severity and characteristics of depression. Analeptic, psychostimulants, neuroleptics, tranquilizers, antidepressants are prescribed.
Family counseling. The patient’s close relatives also need psychological help. The therapist conducts conversations, gives recommendations about changing the relationship with the patient. Support should help restore activity, positive attitude, it is important not to replace it with pity and overprotection.
Prognosis and prevention
The course of depression depends on many factors: the age of the patient, the stage of cancer, the effectiveness of treatment, the presence of relatives. The prognosis is determined individually, but the probability of restoring a normal emotional state is higher with the comprehensive support of medical specialists and close people. To prevent depression, it is necessary to stimulate positive emotions and social activity of the patient. You need to talk, listen, support, involve him in interesting activities (games, cooking, watching comedies with discussion), compensate for the lack of activity – help organize daily rituals, walks, meetings with friends, trips to the cinema.
