Anxiety and Depression in Patients with Cancer. A Case Report

Abstract

Depression is among the leading causes of disability worldwide, leading in some cases, to suicide and it is considered to be the disease of the millennium. Clinical depression is a common disease, and yet frequently overlooked, source of suffering among patients with cancer. Anterior studies indicate that the rate of depression in cancer patients is thought to be up to three times higher than in the general population. Depression decreases the quality of life, compromises the outcomes, and results in increase the rates of mortality from cancer.

Clinical case: We identify a 50-year-old woman diagnosed with bilateral ovarian high-grade serous carcinoma. The imaging investigations revealed multiple metastases (cT3bN1bM1b – TNM classification). This stadium made the patient to be a candidate only for palliative chemotherapy. At first visit at the oncological specialist, the patient was worried about her health condition, but after discussing with the medical oncologist about the treatment and side effects of chemotherapy, the patient gained confidence. During a routine chemotherapy infusion, the patient reports some special side effects like  increase feeling of “going through the motions” as if in a trance-like state, episodes of sudden tearfulness, and feeling like she is “out of control”.

After the finish of the chemotherapy infusion, at the interview, the patient reports feeling safe, denies any self-harm or self-injurious thoughts, denies use of illicit substances and alcohol. She says that the impact of hair loss is very depressive for her. In these conditions, the oncologist decide to discuss an initial treatment plan with her that includes individual counseling. Individual counseling helps the patient to complete her palliative therapies and increase her confident after the post-chemotherapy CT exam result.  However, there is progression of her disease after 6 months. After this exam, she becomes despondent and is struggling to complete daily activities. She reports specific symptoms for depressive disorder: sleeping poorly and lacking appetite, and no longer enjoys spending time with her friends and family or pursuing her interests. She is preoccupied with death and has difficulty concentrating, but fortunately denies any suicidal ideation or death wishes.

It was started the second line chemotherapy protocol. At this time the patient shows abandonment behavior, autolytic thoughts and drug ingestion triggered by acute family conflict, requiring psychiatric re-assessment and specialist treatment.

Conclusion: Depression remains an under-recognised comorbidity in cancer patients, with major implications on patient suffering, mortality and healthcare expenditure. Depression in cancer is markedly different from depression in healthy individuals, and involves a unique symptomatology.