. "3 Quality of Care and Quality Indicators for End-of-Life Cancer Care: Hope for the Best, Yet Prepare for the Worst." Improving Palliative Care for Cancer. Washington, DC: The National Academies Press, 2001.
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Improving Palliative Care for Cancer
depression, and 13 percent of women and 9 percent of men reported moderate or severe anxiety (Donnelly et al., 1995). Using the Diagnostic and Statistic Manual of Mental Disorders, Third Revised Edition (DSM-IIIR) diagnostic criteria adapted for terminally ill patients, 26 percent of terminally ill cancer patients met the criteria for depression (Power et al., 1993).
Thoughts of suicide among terminally ill patients are relatively common (Block, 2000). In a sample of patients with terminal cancer in palliative care hospital units for example, 44.5 percent acknowledged occasional desires for death (Chochinov et al., 1995). Even though the majority of suicidal thoughts among patients with terminal illnesses are transient, the reported suicide rate among patients with cancer is twice that of the general population, with the greatest risk during advanced illness. Moreover, the actual suicide rate among cancer patients may be underestimated since some family members may be unwilling to report that a terminally ill cancer patient died as a result of suicide (Chochinov et al., 1998). Despite the wide variation in reported rates of emotional distress and the difficulty of assessing the true suicide risk among patients with cancer, it is clear that depression, anxiety, and suicidal ideation affect a large enough portion of cancer patients to warrant further research regarding their measurement and the efficacy of both pharmacological and nonpharmacological treatments (e.g., individual or group therapy) that can help patients come to terms with impending death (Block, 2000; Spiegel et al., 1994).
Although there is no consensus regarding the best or most useful tool for diagnosing emotional distress among terminally ill cancer patients, two broad categories of assessment tools have been employed: self-report questionnaires and clinical interview diagnostic criteria. Researchers have used many self-report questionnaires measuring psychological well-being to assess emotional distress among cancer patients; however, only the Memorial Symptom Assessment Scale (Portenoy, et al., 1994b) was designed specifically to measure symptoms common to cancer. Similarly, although standard clinical diagnostic criteria (e.g., the DSM series) are widely used in the general population, versions modified for people with medical illness have to be validated (Kathol et al., 1990), and tools geared toward palliative care that are sensitive to cultural and ethnic differences must be developed (Breitbart et al., 1995; Lewis-Fernandez and Kleinman, 1995).
NCI could fund development of measures, descriptive studies, and research on treatment for anxiety and depression among cancer patients diagnosed as having a life-limiting condition.