Evaluating depression among patients with cancer.

The stress, diagnosis, and treatment of cancer cause substantial psychiatric morbidity that is treatable. Chemotherapy or other cancer treatments cause 40% to 60% of patients' emotional distress. Major depression develops in approximately 25% of patients with cancer, and less severe depressive symptoms develop in many patients, but fewer than half of the patients with symptoms are offered treatment. Alleviating major depression improves the quality of life for these patients with cancer. These patients, particularly during terminal illness, have an increased risk of suicide. Clinicians proficient in psychosocial assessment can detect subtle signs, monitor risk factors, reduce major depression with cognitive strategies, and prevent complications. Untreated major depression lowers life expectancy and treatment compliance and increases risk of suicide and cardiac disease. In this article, incidence of major depression among patients with cancer is discussed. Guidelines for diagnosis, correcting myths, and detecting major depression are suggested. Effective cognitive strategies for intervention are described; medical treatment is briefly reviewed. Detection and evaluation of suicide risk are discussed.