Oncology Institute, Davidoff Center, Rabin Medical Center, Petach Tikvah, Israel.
Cancer J. 2010 Sep-Oct;16(5):493-9. doi: 10.1097/PPO.0b013e3181f28b64.
The incidence of psychological distress-depression, anxiety, delirium-in patients with cancer ranges from 35% to 50%. Demoralization, a new concept, has not been included in most studies. The role of the oncologist in managing depression, anxiety, and demoralization involves diagnosing the problem, providing verbal support, first-line psychotropic medications, and referral to the psycho-oncology team. Empirical studies have shown that oncologists have difficulties in recognizing psychological stress and talking with patients about it. Reasons include a belief that distress is "normal"; the subject matter is embarrassing and uncomfortable; they feel unskilled; and time constraints. Therefore, the role of communication training in medical school and for oncologists in training is important. Screening for psychological distress may identify patients; however, inadequate psychosocial follow up and support may make screening counterproductive. Depression and anxiety constitute most psychological distress and will be described in formal psychiatric terms (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and subjective descriptions. Demoralization, a concept recently introduced to psycho-oncology, is reviewed. Demoralization acts as a bridge from traditional psychiatric terminology to newer concepts used to describe the particular psychological distress characteristic of advanced cancer. Word concepts, such as meaning, spiritual, dignity, and existential, capture the patients' distress that is not defined by formal psychiatric taxonomy. Management modalities for depression, anxiety, and demoralization are discussed.
癌症患者的心理困扰（抑郁、焦虑、谵妄）发生率为 35%至 50%。一种新概念——意志消沉，尚未被纳入大多数研究中。肿瘤学家在处理抑郁、焦虑和意志消沉方面的作用包括诊断问题、提供口头支持、一线精神药物以及向心理肿瘤团队转介。实证研究表明，肿瘤学家在识别心理压力和与患者讨论这方面存在困难。原因包括认为痛苦是“正常的”；主题令人尴尬和不适；他们觉得自己不熟练；以及时间限制。因此，在医学院和培训中的肿瘤学家中进行沟通培训很重要。对心理困扰进行筛查可能会发现患者；但是，不足够的社会心理随访和支持可能会使筛查适得其反。抑郁和焦虑构成了大多数心理困扰，将用正式的精神病学术语（《精神障碍诊断与统计手册》第四版）和主观描述进行描述。最近引入心理肿瘤学的意志消沉概念将进行综述。意志消沉作为从传统精神病学术语到用于描述晚期癌症特有心理困扰的新概念的桥梁。词汇概念，如意义、精神、尊严和存在，捕捉到了无法用正式精神病学分类定义的患者的痛苦。将讨论抑郁、焦虑和意志消沉的管理方式。
