Depression During Treatment

Several issues may contribute to the occurrence of depression in cancer survivors during treatment, including the age of the patient and the specific cancer therapy. Unlike the studies assessing depression at diagnosis, those assessing depression during treatment have relied primarily on patient's self-report and not clinical interviews. This is likely due to the increased time burden that clinical interviews place on patients at a time when the physical side effects may impair the individual's ability to focus for long periods of time. Unfortunately, several studies that have investigated depression in individuals during treatment have failed to provide the proportion of individuals with significant depression, reporting only mean scores instead. This is true in articles by Frost et al.32 who assessed newly diagnosed women with breast cancer treated with adjuvant therapy, and Chen et al.33 who assessed elderly cancer patients with the Geriatric Depression Scale. This same limitation was observed in an article on depression and pain in advanced hormone refractory prostate cancer patients receiving suramin and active therapy.34 Despite that limitation, the study, which assessed individuals prior to therapy, during treatment, and then 3 months after the last dose, documents the decrease in depression scores from baseline to the middle of treatment. Unfortunately, depression subsequently increased at the

2-week posttreatment assessment, before reducing to almost baseline levels at the

3-month assessment. The study provides an example of the variability in depression scores that can occur during the course of treatment.

Additional information on the course of depression during treatment comes from an article examining individuals treated for melanoma with alpha-interferon.35 In that study, Trask et al. assessed individuals for depression prior to initiating interferon therapy, after their high-dose treatment, and then at 1, 2, 3, and 6 months following high-dose treatment (during the time when they are treated with a lower maintenance dose) with the Brief Symptom Inventory and the BDI. Average scores

Assessment point

Figure 1. Changes in Depression in Individuals with Melanoma Over the Course of Interferon Therapy.

Assessment point

Figure 1. Changes in Depression in Individuals with Melanoma Over the Course of Interferon Therapy.

on both the BDI and the BSI-D increased from the first assessment through treatment and did not return to baseline levels by the 6-month assessment (see Figure 1) That said, at any measurement occasion only 17% met or exceeded the cutoffs for significant depression on either the BSI-D or BDI. Nevertheless, the results provide further evidence that cancer therapies can potentially cause symptoms of depression. Further research is needed to determine the mechanisms that may promote the development of depressive symptoms.

Epping-Jordan et al.36 examined depressive symptoms in 80 women with newly diagnosed breast cancer. Women were assessed prior to treatment, with the majority (n = 60, 75%) also completing the study's initial assessment before undergoing any surgical procedure. Responses to the SCL-90-R indicated that at baseline, 34% of the sample had a depression T score above 63, suggestive of a clinical range of depressive symptoms. At 3- and 6-month follow-up (which occurred after most women had completed chemotherapy and/or radiation therapy), the percentage of women above 63 was 29% (n = 23) and 26% (n = 21), respectively. In this and the previous study, depression reduced as the time since diagnosis and treatment lengthened. Although one could conclude that depression may be self-limiting in some cancer survivors, for others, symptoms of depression continue even after the initial treatment has been completed. In the section that follows, the prevalence of depression in cancer survivors following treatment is reviewed along with the various issues that may impact (either positively or negatively) the development of depression.

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