Hematology and Oncology Book

Cancer

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Mood Disorders in CancerAka: Depression in Cancer, Anxiety in Cancer, Mood Disorders in Terminally Ill Patients, Cancer Related Mood Disorders

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  1. See Also
    1. Delirium in Cancer
    2. Preparatory Grief
  2. Epidemiology
    1. Incidence at end of life: 25-77%
  3. Risk Factors
    1. Cancer Pain or other unrelieved Cancer Symptoms
    2. Progressive physical Impairment
    3. Advanced disease
    4. Medications
      1. Corticosteroids
      2. Benzodiazepines
    5. Previous psychiatric illness
      1. Major Depression
      2. Substance Abuse
    6. Specific conditions
      1. Pancreatic Cancer
      2. Cerebrovascular Accident
  4. Evaluation
    1. See Major Depression
    2. Evaluate for Suicidal Ideation
    3. Depression is not inevitable at the end of life
      1. Patients should be able to enjoy their remaining days
  5. Differential Diagnosis
    1. Preparatory Grief
  6. Management: General Measures
    1. See Major Depression
    2. See Anxiety
    3. Psychotherapy: "Be there, be sensitive, be silent"
    4. Employ adjunctive and alternative measures
      1. Massage
      2. Music
      3. Relaxation techniques
    5. Cancer Pain components
      1. Biological
      2. Psychological
      3. Social
      4. Spiritual
    6. Address cancer specific fears
      1. Fear of abandonment by "over-burdened" caretakers
      2. Anticipation of painful death
      3. Fear for family well-being after they die
      4. Fear of spiritual afterlife
  7. Management: Stimulants (preferred agents)
    1. General
      1. Advantages
        1. Onset of Antidepressant effect in days
        2. Decreases Opioid related Sedation
        3. Improves appetite and energy
      2. Contraindications
        1. Agitation
        2. Delirium
        3. Confusion
      3. Precautions: May worsen certain conditions
        1. Anxiety
        2. Dyspnea
        3. Tremulousness
        4. Insomnia
    2. Agents
      1. Dexedrine (Dextroamphetamine)
      2. Methylphenidate (Ritalin)
        1. Start: 5 mg PO qAM and qNoon
        2. Increase: Every 3 days up to 30 mg PO bid
  8. Management: Other agents
    1. Consider starting concurrently with stimulant (above)
    2. Selective Serotonin Reuptake Inhibitor (SSRI)
    3. Tricyclic Antidepressant
  9. References
    1. (2001) JAMA 285(22):2898
    2. Periyakoil (2002) Am Fam Physician 65(5):883

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