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Cancer and Depression

Published online by Cambridge University Press:  06 August 2018

David Spiegel
David Spiegel*
Affiliation:
Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford University School of Medicine, Stanford, CA 94305-5544, US
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Abstract

Half of all cancer patients have a psychiatric disorder, usually an adjustment disorder with depression. Anxiety about illness, such as cancer, often leads to delay in diagnosis, which has been estimated to reduce prospects of long-term cancer survival by 10% to 20%. Although earlier studies showed that depressed individuals were at higher risk for cancer incidence, later studies have not confirmed this predictive relationship. Nonetheless, effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill patients results in reduced anxiety and depression, and often pain reduction. In three randomised studies, psychotherapy resulted in longer survival time for patients with breast cancer (18 months), lymphoma, and malignant melanoma. The physiological mechanisms for these findings have not yet been determined, but four fundamental possibilities for psychotherapeutic effects on physiological change include health maintenance behaviour, health-care utilisation, endocrine environment, and immune function. Thus, effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course. The treatment of depression in these patients may be considered a part of medical as well as psychiatric treatment.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 168 , Issue S30: Comorbidity of Mood Disorders , June 1996 , pp. 109 - 116
Copyright
Copyright © 1996 The Royal College of Psychiatrists 

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References

Ader, R., Felton, D. & Cohen, N. (1990) Interactions between the brain and the immune system. Annual Review of Pharmacology and Toxicology, 30, 561–602.Google Scholar
Ahles, T. A., Blanchard, E. B. & Ruckdeschel, J. C. (1983) Multidimensional nature of cancer-related pain. Pain, 17, 277–288.Google Scholar
Antoni, M. H., Schneiderman, N., Fletcher, M. A., et al (1990) Psychoneuroimmunology and HIV-1. Special Series: Acquired Immune Deficiency Syndrome. Journal of Consulting and Clinical Psychology, 58, 38–49.CrossRefGoogle Scholar
Bagenal, F. S., Easton, D. F., Harris, E., et al (1990) Survival of patients with breast cancer attending Bristol Cancer Help Centre. Lancet, 336, 606–610.Google Scholar
Bond, M. R. (1973) Personality studies in patients with pain secondary to organic disease. Journal of Psychosomatic Research, 17, 257–263.Google Scholar
Bond, M. R. & Pearson, I. B. (1969) Psychological aspects of pain in women with advanced cancer of the cervix. Journal of Psychosomatic Research, 13, 13–19.Google Scholar
Bovard, E. W. (1985) Brain mechanisms in effects of social support on viability. Perspectives on Behavioral Medicine, 2, 103–129.CrossRefGoogle Scholar
Burish, T. G. & Lyles, J. N. (1981) Effectiveness of relaxation training in reducing adverse reactions to cancer chemotherapy. Journal of Behavioral Medicine, 4, 65–78.CrossRefGoogle ScholarPubMed
Cain, E., Kohorn, E. & Quinlan, D. (1986) Psychosocial benefits of a cancer support group. Cancer, 57, 183–189.Google Scholar
Carroll, B. T., Kathol, R. G., Noves, R. Jr., et al (1993) Screening for depression and anxiety in cancer patients using the Hospital Anxiety and Depression Scale. General Hospital Psychiatry, 15, 69–74.Google Scholar
Chrousos, G. P. & Gold, P. W. (1992) The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. Journal of the American Medical Association, 267, 1244–1252.CrossRefGoogle ScholarPubMed
Derogatis, L. R., Morrow, G. R., Fetting, J., et al (1983) The prevalence of psychiatric disorders among cancer patients. Journal of the American Medical Association, 249, 751–757.CrossRefGoogle ScholarPubMed
Evans, D. L., McCartney, C. F., Nemeroff, C. N., et al (1986) Depression in women treated for gynecological cancer: clinical and neuroendocrine assessment. American Journal of Psychiatry, 154, 447–452.Google Scholar
Evans, D. L., Folds, J. D., Petitto, J. M., et al (1992) Circulating natural killer cell phenotypes in men and women with major depression: relation to cytotoxic activity and severity of depression. Archives of General Psychiatry, 49, 388–395.CrossRefGoogle ScholarPubMed
Fawzy, F. I., Cousins, N., Fawzy, N. W., et al (1990a) A structured psychiatric innovation for cancer patients: I. Changes over time and methods of coping in affect of disturbance. Archives of General Psychiatry, 47, 720–725.Google Scholar
Fawzy, F. I., Cousins, N., Fawzy, N. W., et al (1990b) A structured psychiatric intervention for cancer patients. II. Changes over time in immunological measures. Archives of General Psychiatry, 47, 729–735.CrossRefGoogle ScholarPubMed
Fawzy, F. I., Fawzy, N. W., Hyun, C. S., et al (1993) Malignant melanoma: Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Archives of General Psychiatry, 50, 681–689.Google Scholar
Ferlic, M., Goldman, A. & Kennedy, B. J. (1979) Group counseling in adult patients with advanced cancers. Cancer, 43, 760–766.Google Scholar
Forester, B., Kornfeld, D. S. & Fleiss, J. L. (1985) Psychotherapy during radiotherapy: Effects on emotional and physical distress. American Journal of Psychiatry, 142, 22–27.Google ScholarPubMed
Fox, B. H. (1989) Depressive symptoms and risk of cancer. Journal of the American Medical Association, 262, 1231.Google Scholar
Gellert, G. A., Maxwell, R. & Siegel, B. S. (1993) Survival of breast cancer patients receiving adjunctive psychosocial support therapy: a 10-year follow-up study. Journal of Clinical Oncology, 11, 66–69.Google Scholar
Glaser, R., Kiecolt-Glaser, J. K., Speicher, C. E., et al (1985) Stress-related impairments in cellular immunity. Psychiatric Research, 16, 233–239.CrossRefGoogle ScholarPubMed
Gold, P. W., Goodwin, F. K. & Chrousos, G. P. (1988a) Clinical and biochemical manifestations of depression: relation to the neurobiology of stress, Part I. New England Journal of Medicine, 319, 348–353.Google Scholar
Gold, P. W., Goodwin, F. K. & Chrousos, G. P. (1988b) Clinical and biochemical manifestations of depression: Relation to the neurobiology of stress, Part II. New England Journal of Medicine, 319, 413–420.Google Scholar
Goodwin, J. S., Hunt, W. C., Key, C. R., et al (1987) The effect of marital status on stage, treatment and survival of cancer patients. Journal of the American Medical Association, 158, 3125–3130.Google Scholar
Gustafson, J. & Whitman, H. (1978) Towards a balanced social environment on the oncology service. Social Psychiatry and Psychiatric Epidemiology, 13, 147–152.Google Scholar
Hahn, R. C. & Petitti, D. B. (1988) Minnesota Multiphasic Personality Inventory – rated depression and the incidence of breast cancer. Cancer, 621, 845–848.3.0.CO;2-Q>CrossRefGoogle Scholar
Hayes, R. J., Smith, P. G. & Carpenter, L. (1990) Bristol Cancer Help Centre. Lancet, 336, 1185–1188.Google Scholar
Hendler, N. (1984) Depression caused by chronic pain. Journal of Clinical Psychiatry, 45, 30–36.Google ScholarPubMed
Herberman, R. B. & Ortaldo, J. R. (1981) Natural killer cells: their role in defenses against disease. Science, 214, 24–30.Google Scholar
Hilgard, E. R. & Hilgard, J. R. (1975) Hypnosis in the Relief of Pain. Los Altos, CA: William Kaufman.Google Scholar
Holland, J. C. (1989) Fears and abnormal reactions to cancer in physically healthy individuals. In Handbook of Psychooncology (eds. Holland, J. C. & Rowland, J. H.), pp. 13–21. New York: Oxford University Press.Google Scholar
House, J. S., Landis, K. R. & Umberson, D. (1988) Social relationships and health. Science, 241, 540–544.Google Scholar
Irwin, M. R., Daniels, M., Bloom, E. T., et al (1987) Life events, depressive symptoms, and immune function. American Journal of Psychiatry, 144, 437–444.Google Scholar
Irwin, M. R. & Strausbaugh, H. (1991) Stress and immune changes in humans: a biopsychosocial model. In Psychoimmunology Update (eds Gorman, J. M. & Kertzner, R. M.), pp. 55–79. Washington, DC: APP.Google Scholar
Israel, L. (1989) Psychological support for cancer patients. Lancet, 2, 1209–1210.Google Scholar
Kaplan, G. A. & Reynolds, P. (1988) Depression and cancer mortality and morbidity: prospective evidence from the Alameda County Study. Journal of Behavioral Medicine, 11, 1–13.CrossRefGoogle ScholarPubMed
Katon, W. & Sullivan, M. D. (1990) Depression and chronic medical illness. Journal of Clinical Psychiatry, 56 (suppl.), 3–11.Google Scholar
Kennedy, S., Kiecolt-Glaser, J. & Glaser, R. (1988) Immunological consequences of acute and chronic stressors: mediating role of interpersonal relationships. British Journal of Medical Psychology, 61, 77–85.CrossRefGoogle ScholarPubMed
Lansky, S. B., List, M. A., Herrmann, C. A., et al (1985) Absence of major depressive disorder in female cancer patients. Journal of Clinical Oncology, 3, 1553–1560.Google Scholar
Levine, S., Coe, C. & Wiener, S. G. (1989) Psychoneuroendocrinology of stress: a psychobiological perspective. In Psychoendocrinology (eds Brush, F. R. & Levine, S.), pp. 341–377. New York: Academic Press.Google Scholar
Levy, S., Lippman, M. & D'Angelo, T. (1987) Correlation of stress factors with sustained compression of natural killer cell activity and predictive prognosis in patients with breast cancer. Journal of Clinical Oncology, 5, 348–353.CrossRefGoogle Scholar
Malarkey, W. B., Kennedy, M., Allerd, L. E., et al (1983) Physiological concentration of prolactin can promote the growth of human breast tumor cells in culture. Journal of Clinical Endocrinology and Metabolism, 56, 673–677.CrossRefGoogle ScholarPubMed
Massie, M. J. & Holland, J. C. (1987) The cancer patient with pain: psychiatric complications and their management. Cancer Pain, 71, 243–258.Google Scholar
McDaniel, J. S. & Nemeroff, C. B. (1993) Depression in the cancer patient: diagnostic, biological, and treatment aspects. In Current and Emerging Issues in Cancer Pain: Research and Practice (eds Chapman, C. R. & Foley, K. M.), pp. 1–19. New York: Raven Press.Google Scholar
Morrow, G. R. & Morrell, C. (1982) Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy. New England Journal of Medicine, 307, 1476–1480.Google Scholar
Myers, J. K., Weissman, M. M., Tischler, G. L., et al (1984) Six-month prevalence of psychiatric disorders in three communities. Archives of General Psychiatry, 41, 959–967.Google Scholar
Nemeroff, C. B. (1991) Corticotropin-releasing factor. In Neuropeptides and Psychiatric Disorders (ed. Nemeroff, C. B.), pp. 75–91. Washington, DC: APP.Google Scholar
Persky, V. W., Kempthorne-Rawson, J. & Shekelle, R. B. (1987) Personality and risk of cancer: twenty year follow-up of the Western Electric Study. Psychosomatic Medicine, 49, 435–449.Google Scholar
Peteet, J., Tay, V., Choen, G., et al (1986) Pain characteristics and treatment in an outpatient cancer population. Cancer, 57, 1259–1265.Google Scholar
Radloff, L. S. (1977) The CES-D Scale: a self-report depression scale for research in the general population. Journal of Applied Psychological Measurement, 1, 385–401.Google Scholar
Ramirez, A. (1989) Stress and relapse of breast cancer. British Medical Journal, 298, 291–293.Google Scholar
Richardson, J. L., Shelton, D. R., Krailo, M., et al (1990) The effect of compliance with treatment on survival among patients with hematologic malignancies. Journal of Clinical Oncology, 8, 356–364.Google Scholar
Rose, R. M. (1984) Overview of endocrinology of stress. In Neuroendocrinology and Psychiatric Disorder (ed. Brown, G. M.), pp. 95–122. New York: Raven Press.Google Scholar
Schleifer, S. J., Keller, S. E., Siris, S. F., et al (1985) Depression and immunity. Archives of General Psychiatry, 42, 129–133.CrossRefGoogle ScholarPubMed
Schleifer, S. J., Keller, S. E., Bond, R. N., et al (1989) Major depressive disorder and immunity. Archives of General Psychiatry, 46, 81–87.Google Scholar
Shafie, S. & Brooks, S. C. (1977) Effect of prolactin on growth and estrogen receptor level of human breast cancer (MCF-7). Cancer Research, 37, 792–799.Google Scholar
Sheard, T. A. B. (1990) Bristol Cancer Help Centre. Lancet, ii, 1185–1186.Google Scholar
Shekelle, R. B., Raynor, W. J., Ostfeld, A. M., et al (1981) Psychological depression in seventeen year risk of death from cancer. Psychosomatic Medicine, 43, 117–125.Google Scholar
Spiegel, D. (1990) Facilitating emotional coping during treatment. Cancer, 66, 1422–1426.Google Scholar
Spiegel, D. (1991) Mind matters: Effects of group support on cancer patients. Journal of NIH Research, 3, 61–62.Google Scholar
Spiegel, D. (1993a) Psychosocial intervention in cancer. Journal of the National Cancer Institute, 85, 1198–1205.Google Scholar
Spiegel, D. (1993b) Living Beyond Limits: New Help and Hope for Facing Life-Threatening Illness. New York: Times Books.Google Scholar
Spiegel, D. (1994) Health caring: psychosocial support for patients with cancer. Cancer, 74 (suppl.), 1453–1457.Google Scholar
Spiegel, D., Bloom, J. R. & Yalom, I. D. (1981) Group support for patients with metastatic cancer. A randomized prospective outcome study. Archives of General Psychiatry, 38, 527–533.CrossRefGoogle Scholar
Spiegel, D. & Bloom, J. R. (1983a) Pain in metastatic breast cancer. Cancer, 52, 341–345.Google Scholar
Spiegel, D. & Bloom, J. R. (1983b) Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine, 45, 333–339.CrossRefGoogle ScholarPubMed
Spiegel, D. & Sands, S. (1988) Pain management in the cancer patient. Journal of Psychosocial Oncology, 6, 205–216.CrossRefGoogle Scholar
Spiegel, D., Bloom, J., Kraemer, H. C., et al (1989) Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, ii, 888–891.Google Scholar
Spiegel, D., Sands, S. & Koopman, D. (1994) Pain and depression in patients with cancer. Cancer, 74, 2570–2578.Google Scholar
Tross, S. & Holland, J. C. (1989) Psychological sequelae in cancer survivors. In Handbook of Psycooncology: Psychological Care of the Patient With Cancer (eds Holland, J. C. & Rowland, J. H.), pp. 44–57. New York: Oxford University Press.Google Scholar
Turns, D. M. (1988) Psychosocial factors. In Cancer of the Breast (3rd edn) (eds Donegan, W. L. & Spratt, J. S.), pp. 728–738. Philadelphia: W. B. Saunders.Google Scholar
Wood, P. E., Milligan, J., Christ, D., et al (1978) Group counseling for cancer patients in a community hospital. Psychosomatics, 19, 555–561.Google Scholar
Woodforde, J. M. & Fielding, J. R. (1970) Pain and cancer. Journal of Psychosomatic Research, 14, 365–370.Google Scholar
Zeltzer, L. & LeBaron, S. (1982) Hypnosis and nonhypnotic techniques for reduction of pain and anxiety during painful procedures in children and adolescents with cancer. Journal of Pediatrics, 101, 1032–1035.Google Scholar
Zonderman, A. B., Costa, P. T. & McCrae, R. R. (1989) Depression as a risk for cancer morbidity and mortality in a nationally representative sample. Journal of the American Medical Association, 262, 1191–1195.Google Scholar
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