Frequency of Depression Among Cancer Patients

Introduction Cancer is a term used to describe a group of diseases characterized by an abnormal growth of cells which have the ability to invade adjacent tissues and even distant organs. 1 Cancer patients suffer from both bodily as well as psychosomatic symptoms. There are numerous types and variations of depressive disorders, but the common clinical manifestations are depressed mood, persistent body aches, loss of pleasure in work and life, easy fatigability and sleep as well as appetite disturbances. Taking into account depressive disorders among cancer patients is important because of its commonness, cost and colossal effects on the personality. 2 6 Depressive disorders are well-known in patients suffering from chronic fatal diseases. Cancer survivors are more prone to such disorders because of prolonged bodily symptoms, high cost of treatment and fear of reemergence. Delay in the diagnosis of major depression among cancer patients leads to worsening of the quality of daily living, longer stay in hospitals and reduces their conformity with management. 4, 7, 8 There are many difficulties in making a diagnosis of psychological problems among cancer patients. These comprise of apprehension regarding mental illness, distraction from cancer treatment, scarcity of time and facilities for mental health appraisal, and lack of team work between oncologists and psychiatrists. Over the last few years, many efforts have been made in order to improve screening procedures, but at present no ORIGINAL ARTICLE Annals of PIMS ISSN:1815-2287 Ann. Pak. Inst. Med. Sci. 2017 84 standardized approach exists for the diagnosis of depression among cancer patients. Despite advances in the early detection and effective treatment, cancer remains the most feared disease. Routine screening for depression and distress is internationally recommended as a necessary standard for good cancer care, given its high prevalence and negative consequences on the quality of life. In the field of psycho-oncology, many instruments are used for detecting depression and psychological distress like BSI (Brief Symptoms Inventory), HADS (Hospital Anxiety and Depression Scale) and BDI Scoring (Beck’s Depression Inventory) which consists of 21 questions each scoring 0 – 3. The highest possible total for the whole test would be sixty-three. Depression is evaluated according to the scores obtained by the patients. 6, 11 Frequency of depression ranges from 8.258 % 4, 10 in different studies, and with progression in cancer stage, depression also increases in patients. Physical illness adversely affects the mental health and has negative effects on the quality of life. 12 The prevalence of depression in cancer patients can help us know the mental health of patient being affected by the disease. Worldwide cancer is second only to coronary artery disease as being the most common cause of death. In Pakistan also the number of cancer patients is increasing day by day. There are studies regarding the etiology and pathogenesis of the disease, but only a few relating to psychological stress among cancer patients. We conducted this study to find out the frequency of depression among cancer patients, so that proper treatment either psychotherapy or medicines would be prescribed to them to improve their quality of life as well as compliance to cancer treatment. Methodology This was a hospital based cross-sectional study, conducted at POF hospital Wah Cantt, DHQ Hospital Rawalpindi and NORI Islamabad from January 2015 to June 2015. Concerned authority in hospitals was approached for permission, as well as informed consent was taken from patients before data collection. A total of 116 patients (Using WHO calculator following are the calculations: Confidence level 95%, anticipated prevalence 8.2 %, absolute precision required 5 %, Sample size (n) 116) were selected. Patients at the terminal stages were excluded. Selected patients were provided with questionnaire consisting of information related to socio-demographic profile of patients, disease related record and BDI (Beck Depression Inventory) questions (translated into Urdu), for the assessment of depression in cancer patients. The data was analyzed by using SPSS-v19 and chi-square test was applied to determine the significance of results. The Beck depression inventory is a 21-item scale assessing: sadness, distrust, feeling of disappointment, dissatisfaction, guiltiness, feeling of retribution, selfblame, suicidal thinking, crying, bad temper, loss of interest, lack of decision making, work capacity, sleep problems, low energy, decreased appetite, weight loss, worries about health and lack of interest in sex. The scale ranges from 0 to 3, with zero indicating absence of the symptom and 3 maximum presence of the symptom. Scores can range from 0 to 63. Patients having BDI (Beck’s Depression Inventory) score up to 20 (out of total 63) were labeled as having no depression while those having score greater than 20 were labeled as having depression. Results In the sample size of 116, there were 72 males and 44 females. Out of total, 18 patients had the income under 10,000, 67 patients had an income ranging between 10,000 & 25,000 and 31 had income greater than 25,000. Regarding literacy status 35 (30.2%), 34 (29.3%) and 47 (40.5%) patients had education up to primary, middle and graduation, respectively. The frequency of different types of cancers was Lymphoma/ Sarcoma 7 (6%), CA breast 20 (17.2%), CA lung 13(11.2%), GIT cancers 23 (19.8%), Gynecological CA 14 (12.1%), Prostate/ bladder CA 26 (22.4%), Leukemia 4 (3.4%), and Oral/ thyroid CA 9 (7.8%). In the treatment strategies 75 (64.7%), 28 (24.1%) and 13 (11.2%) patients were treated with surgery, chemotherapy and radiotherapy respectively. Twenty six (22.4%), 50 (43.1%) and 40 (34.5%) patients were in cancer stage I, II and III respectively. About 68 (58%) patients were having depression in 116 selected patients (Fig. 1). Sixty percent males and 57% females had the depression. The frequency of depression was more in stage III as compare to stage I and II, and the results were statistically significant (p-value 0.000 Table I). Depression rate significantly increases with duration of cancer (p-value 0.001 Table II). The rate of depression was 48%, 75% and 85% among patients having surgical treatment, chemotherapy and radiotherapy respectively. Results regarding the relationship of depression with gender, education and income were statistically insignificant (p-values 0.75, 0.58 and 0.18 respectively). Frequency of depression was relatively high in patients with Prostate/ bladder CA (77%), Lymphoma/ Sarcoma Annals of PIMS ISSN:1815-2287 Ann. Pak. Inst. Med. Sci. 2017 85 (71%), breast CA (70%), and Oral/ thyroid CA (67%) as compared to Leukemia, lung cancer, GIT and Gynecological CA (50%, 38%, 43% and 43% respectively Figure. 2). Table I:Frequency of depression according to stage of