36 Could a similar effect of depression be true for patients with cancer as well?

A meta-analysis by Satin and colleagues37 published in 2009 suggests that depression may predict mortality in cancer patients. Out of 9417 patients, those with depressive symptoms had a 26% greater mortality, and those diagnosed with major depressive disorder had a 39% higher mortality, an effect that was independent of other risk factors. In a retrospective cohort study of women with breast cancer, Danish investigators observed a modest, cancer phasedependent increase in mortality in women who had preoperative or postoperative depression.38 A smaller retrospective study of patients Inhibitors,research,lifescience,medical with malignant brain astrocytomas found that preoperative depression was independently associated with decreased survival at 12 and 20 months.39 To be sure, these observations require confirmation

in larger, prospective studies. Inhibitors,research,lifescience,medical Furthermore, even if a negative prognostic effect of depressive symptoms is established for cancer, it will need to be demonstrated that the early detection and successful treatment of depression positively impacts survival. Until then, the most compelling rationale for depression screening and treatment remains the AMD3100 purchase clinical imperative to relieve suffering and Inhibitors,research,lifescience,medical improve functioning. Depression and decision-making Modern cancer care presents patients with challenging decisions that begin Inhibitors,research,lifescience,medical with screening tests (eg, serum prostatic specific antigen levels, BRCA1 status) and continue through end-of-life care. As death approaches, patients and their caregivers are frequently faced with treatment options that hold diminishing chances of benefit and escalating likelihood of toxicity. Making these choices is particularly difficult when decision-making is colored by physical discomfort, existential fear, or depression. Not surprisingly, a patient’s decision to discontinue active cancer treatment is a common trigger for psychiatric assessment of depression. Basic components of decision-making Inhibitors,research,lifescience,medical capacity (DMC) include knowledge, intellectual skills, memory, attention, concentration, conceptual organization,

and aspects of “executive function” such as the ability to plan, solve problems, and make probability determinations. Most of the psychiatric literature on DMC is focused on these cognitive functions and employs psychometric not approaches to the study of subjects with neuropsychiatric illnesses such as dementia, psychosis, major depression, and bipolar disorder.- In contrast, the contributions of mood, motivation, faith, and other influences on risk assessment and decision-making have received less attention but have clear implications for end-of-life care. The extent to which these factors, and less easily quantified concepts like intuition, trust, or ambivalence affect the decision-making process is not known.