Oct 7, 2020
David Henry, MD, host of the Blood & Cancer podcast, joins
Psychcast host Lorenzo Norris, MD, to discuss steps clinicians can
take to alleviate the distress associated with receiving a
diagnosis of cancer.
Henry is clinical professor of medicine at the University of
Pennsylvania, Philadelphia. He has no disclosures. Dr.
Norris is director of consult liaison psychiatry at George
Washington University, Washington. He has no disclosures.
- Cancer patients have always been susceptible to developing
depression and anxiety after receiving their distressing diagnoses.
During the COVID-19 pandemic, the risk for depression and anxiety
are even greater because patients face separation from their
oncology treatment teams and for some, delays in treatment.
- Major depressive disorder (MDD) occurs in up to one-third of
cancer patients, and any depressive disorder can be seen in about
- Another concern is how to screen for depression in the context
of cancer. Dr. Norris suggests using the Patient Health
screener, or the question: “Are you sad or depressed?” Answering
those questions can give patients the opportunity to open up about
- Signs of depression in cancer include nonadherence to
treatment, changes in mood and anxiety affecting daily functioning
at home or work, and demoralization, which is defined as
helplessness, isolation, and despair in the face of overwhelming
- An emotional upset, such as disbelief, despair, or even denial,
might occur immediately after receiving a cancer diagnosis. A
depressive disorder, however, is a persistently depressed, sad mood
with changes in functioning that affect the patient, his/her
family, and even engagement with treatment.
- Findings of studies about the prevalence of depression in
patients with cancer vary depending on the type of screening and/or
diagnostic tool used. In general, the prevalence of MDD is up to
38%, and the prevalence of any depressive disorder is up to 58%.
The prevalence of depression is even greater in patients with
advanced cancer. In the general population, the 12-month prevalence
of MDD is 6%, and the lifetime prevalence is 16%.
- It’s useful to think about stress along a continuum of
diagnoses ranging from a normal expected stress syndrome, an
adjustment disorder, MDD triggered by the event, depression
secondary to a general medical condition as can occur in central
nervous system and pancreatic cancer, or even a substance-induced
mood disorder from either prescribed medications or perhaps a form
of coping that has turned maladaptive.
- Cognitive-behavioral therapy (CBT) can be explained as
examining the way thoughts influence emotions and behavior. When
using CBT with cancer patients, a good place to start is checking
in on their understanding of their diagnosis, their prognosis, and
current and future treatments. The goal is to see whether they have
unnecessary cognitive distortions that may be affecting their
emotions and behaviors. During periods of extreme stress, CBT can
help patients by emphasizing the use of adaptive thoughts, and
identifying maladaptive thoughts and behaviors as opportunities for
- To screen for depression, it may be enough to ask: “Are you
depressed?” As a screening tool, the PHQ-2 asks only two questions:
“Over the last 2 weeks, how often have you been bothered by the
following problems: Little interest or pleasure in doing things, or
been feeling down, depressed or hopeless? The PHQ-2 score ranges
from 1 to 6, and even at the lowest score, it has a sensitivity and
specificity of 90.6% and 65.4%, respectively, in detecting any
Krebber AMH et al. Psycho-oncology.
Walker J et al.
Ann Oncol. 2013 Apr 1;24(4):895-900.
Trinidad AC et al.
Psychiatr Ann. 2011;4(9):439-42.
Daniels S. J Adv Pract
Oncol. 2015 Jan-Feb;6(1):54-6.
National Cancer Institute: Depression–Health Professional