Tuesday, 19 August 2008

Depression in people with cancer is not "normal"

A recent study reported widely (although not referenced) has shown that feeling significantly depressed occurred in 8% of a sample of 2900 people with cancer in the UK compared to 2.6% in the general population. The study was done by the Psychological Medicine Research group at the University of Edinburgh. It builds on ten years of major work in this area including their recent Lancet RCT which used problem solving therapy (amongst other interventions) in depressed people (Strong, V., Waters, R., Hibberd, C., Murray, G. D., Wall, L., McHugh, G. L., Walker, A., & Sharpe, M. 2008,"Management of depression for people with cancer (SMaRT oncology 1): a randomised trial",The Lancet - Vol. 372, Issue 9632, 5 July 2008, Pages 40-48).

The fact that depression is common in people with cancer is not on the face of it that surprising. When bad things happen to people they grieve for what they have lost - which includes going through a period of depression. Maybe what is more surprising is that 92% of people reported not feeling significantly depressed. In liaison psychiatry one of the major day to day issues is the problem of other health professions not recognising significant depression because it is "understandable" or normal. One take home message from this study is that even when bad things happen most people do not get depressed and feeling that they would be better off dead is not a normal and "understandable" reaction.

1 comment:

Anonymous said...

I wonder if doctors, nurses, clinicans, notice whether Depression and Anxiety is a problem for people with cancer, because of the enormous emphasis that is put upon people who experience cancer to be 'positive'.

My own experience with an invasive cancer is that after the initial diagnosis, no opportunity was given to express any 'negative' feelings, like fear, depression, anxiety and any attempt to raise the subject of anthing people label 'negative' resulted in being told off! It was so bad that I was even told that saying these things could result in me causing the cancer to come back, or to spread! With this sort of pressure, who could be brave enough to say what they really feel or think?

With this approach being dominant in NZ- and I've met many others who say the same thing happens to them 'evidence based ' medicine takes on a whole new dimension when 'evidence' is simply biased.

It only took a couple of bad experiences with being honest for me to start lying about how I felt to health professionals and keep the truth for a very few friends who wern't afraid to hear my fear, anxiety, depression etc.

I also take issue with grief being the major emotional issue. Cancer is life threatening. Fear is and was far greater for me than grief. Grieving for lost body parts etc pales in comparison to facing our own mortality.

It's easy to make people with cancer 'other' and to project theories upon them.

We're just people who have often had to face what is often untimely death, and deal with what I describe above, as well as pain, and treatments which are toxic and make us feel horrible.

No doubt people differ hugely in their responses. I guess the other issue is to follow up long after the cancer is meant to be 'over' and see how people fare over time. Maybe people who havn't experienced cancer aren't aware that part of the clinical practice is that an oncologist gives very explicit details concerning exactly what they extimate the chances are of recurrence and of surviving at all, in increments of 5 years, 7 years and so on. It is a sobering thing to process being told there is only a 40% chance of cancer free survival as I was.

What I longed for was the opportunity to be real about how I was feeling, and I also longed for people to stop talking 'at me' and listen sometimes, because I felt I occaisionally had valuable insights and experiences to pass on, that could be used to influence 'evidence based' practices. Sadly, that hasn't happened very often in a medical context.