Depression in Advanced Cancer Patients

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Depression in Advanced Cancer Patients
Depression in Advanced
Cancer Patients
Bunty Anderson, BSW
Clinician, Psychosocial Oncology,
CancerCare Manitoba, SBGH Site
CCPN Provincial Conference
September 30, 2011
GOALS
‹ What
are the most salient points to
cover in the short time we have?
DEPRESSION
‹
1) How prevalent is depression?
‹
2) What increases a patent’s vulnerability?
‹
‹
‹
3) Differentiating depression from vegetative
signs of illness….and…..
4) Differentiating depression from grief.
5) and if we have time = thoughts on
compliance.
DEPRESSION
‹ The
material presented today is
taken from clinical experience and
EPEC-O Canada. (Education in
Palliative and End of Life Care for
Oncology Health Professionals)
QUICK REVIEW ON WHAT
DEPRESSION LOOKS LIKE
‹ Depressed
Mood
‹ Anhedonia
(loss of pleasure or
interest)
‹>
2 weeks duration
DEPRESSION
‹
‹
Irritability
Changes in appetite or weight
‹ Sleep
‹ Psychomotor
‹
‹
‹
activity
Decreased Energy
Guilt/Worthlessness
Helplessness, Hopelessness
DEPRESSION
‹ DIFFICULTY:
‹
‹
‹
‹
Thinking
Concentrating
Making decisions
Suicidal ideation or a wish to hasten death
‹ How
prevalent is depression in
patients with advanced disease?
PREVALENCE
‹ Up
to 58% of cancer patients
RISK FACTORS
‹
What increases vulnerability?
‹
Poorly controlled pain.
‹
Progressive physical impairment.
‹
Advanced disease.
‹
Medications: (e.g.) Steroids, Chemotherapeutics.
RISK FACTORS
‹
Particular diseases:
‹
Pancreatic, Breast, Lung, CNS metastases
‹
Younger age
‹
Spiritual pain
‹
Conflicts over issues of meaning, guilt and
fear
TREATMENT
‹ SSRI’s:
Lower side effect profile.
‹ Psycho
stimulants to hasten
response in palliative population.
‹ Medication
results.
and counselling get best
DEPRESSION and VEGETATIVE
SIGN OF ILLNESS
‹
SIMILARITIES:
‹ Eating
changes
‹ Sleeping changes
‹ Libido changes
‹ Fatigue
‹ Difficulty concentrating
‹ Trouble with decision making
‹ Low mood/withdrawn
DEPRESSION vs ILLNESS
‹ DIFFERENCES:
‹ Persistent
weepiness
‹ Increase Irritability
‹ Social avoidance
‹ Hopelessness: “Why Bother?”
‹ Suicidality
‹ Anhedonia
SIMPLE ASSESSMENT
QUESTIONS
‹ 1)
Do you feel depressed most of the
time?
‹ 2)
Are you able to take pleasure in
the thing’s you normally have
enjoyed?
ASSESSMENT
‹ Involve
‹ What
the family where possible
are they seeing?
DEPRESSION? or GRIEF?
‹ With
grief, feelings of sadness and
low mood are episodic.
‹ Pleasure
‹ Warmth,
can still be experienced.
affection and emotional
presence comforts the bereaved.
WITH DEPRESSION
‹ Low
mood is pervasive and
oppressive.
‹ Pleasure
‹ Others
is absent. (anhedonia)
do not bring comfort.
ASSESSMENT QUESTION
‹ 1)
Does your low mood come and
go?
‹ 2)
Can you still take pleasure in
things you’ve enjoyed in the past?
DISPELLING MYTHS
‹ By
educating the patient, we can
increase compliance.
‹ Time
for Questions / Discussion

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