Depression is a common mood disorder in patients with cancer, and it may have far-reaching effects on patients’ well-being. The approach to treatment includes medications as well as therapy without medications, but there is no sufficient evidence to recommend any particular medication over another or any other type of therapy.
Higher Depression Rates in Patients with Cancer
Depression is more common in patients with cancer than in the general population of the United States. The rate of depression in patients with cancer ranges from 23% to 60% and may be up to 3 times higher than in the general population.1
The increased rate of depression in patients with cancer can be the result of the cancer diagnosis itself, the cancer type and stage of cancer, or the result of the treatment. For example, the rates of depression are typically higher in patients with pancreatic, oropharyngeal, or breast cancers, and lower in those diagnosed with lymphoma, leukemia, or gastric cancer. As can be expected, the symptoms of depression are more prevalent in patients with advanced cancer than in those with earlier-stage disease, and the rates of depression tend to increase as the disease severity increases.
Younger age may also be a contributing factor for depression in patients with cancer, because cancer is often associated with restrictions and disruptions to the life and work of younger people. In comparison, older people may view their situation in a different frame of reference and tend to attribute their health problems to being a “normal” part of aging.2
Although common in patients with cancer, depression is often underdiagnosed and undertreated in these patients, for many reasons. Depressive symptoms, such as fatigue, insomnia, cognitive impairment, and decreases in appetite and energy, are similar to the symptoms of cancer or the side effects of cancer treatment. Even the more classic symptoms of depression, such as hopelessness, suicidal ideation, and passive death wishes, can easily be rationalized by medical staff as being responses to the cancer itself and its prognosis rather than being warning signs of a treatable disorder.1
Heightened Risks for Patients with Depression and Cancer
For patients with cancer, depression may have far-reaching effects on their well-being, because it may involve significant pain and suffering, poor quality of life, and reduced adherence to cancer treatment, and may lead to suicide, place a psychological burden on the family, and prolong the length of hospital stay.3
Depression may even increase the mortality risks in patients with cancer who are depressed, because they may be less likely to adhere to preventive procedures, cancer treatments, or other recommendations for improving and maintaining their health. For example, patients with depression may be less likely to engage in regular exercise or other forms of physical activity, more likely to smoke and drink alcohol to excess, and not adhere to prescribed medication regimens, or miss therapy appointments.4
Severe symptoms of depression could also cause other significant impairments, such as prolonged hospital stays and frequent readmissions to the hospital, and may even lead to suicide. The suicide rate among patients with cancer is twice as high as that of the general population.5 To prevent suicidal acts in patients with cancer, the medical staff should closely monitor any symptoms of depression, along with other warning signs for suicide, such as feelings of demoralization, pain, and a lack of social support.5
Two Types of Treatment for Depression in Patients with Cancer
Broadly speaking, there are pharmacologic and nonpharmacologic approaches for the treatment of depression in patients with cancer. Pharmacologic interventions involve the use of medications, such as antidepressants, and nonpharmacologic approaches are usually psychological therapies, such as cognitive behavioral therapy.
For patients with late-stage cancer, psychotherapy may be a better intervention than medications, because patients may not always tolerate antidepressants well. Research has shown that psychotherapy is associated with a significant decrease in depression, which suggests a moderate impact on patients with advanced cancer.3
Research also supports the use of antidepressant medications for the treatment of more severe depression, and psychological therapies for mild-to-moderate depression for patients at different stages of the cancer. However, the choice of treatment should be personalized to the individual patient and the specific symptoms, because there is insufficient evidence to recommend any particular medication or psychotherapy over another.6
Overall, psychological interventions can be considered as the first treatment for those with mild-to-moderate depression, and medications can be added for those with severe depression, which optimally should be delivered as part of a collaborative care model.
- Barrera I, Spiegel D. Review of psychotherapeutic interventions on depression in cancer patients and their impact on disease progression. International Review of Psychiatry. 2014;26:31-43.
- Götze H, Friedrich M, Taubenheim S, et al. Depression and anxiety in long-term survivors 5 and 10 years after cancer diagnosis. Supportive Care in Cancer. 2020;28:211-220.
- Okuyama T, Akechi T, Mackenzie L, Furukawa TA. Psychotherapy for depression among advanced, incurable cancer patients: a systematic review and meta-analysis. Cancer Treatment Reviews. 2017;56:16-27.
- Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychological Medicine. 2010;40:1797-1810.
- McFarland DC, Walsh L, Napolitano S, et al. Suicide in patients with cancer: identifying the risk factors. Oncology (Williston Park). 2019;33:221-226.
- Panjwania AA, Li M. Recent trends in the management of depression in persons with cancer. Current Opinion in Psychiatry. 2021;34:448-459.