M Miovic, S Block. Psychiatric disorders in advanced cancer. Cancer 2007;110(8):1665-76.

Because of the low rate of complications from treatment of depression, experts recommend a strategy of ‘‘if in doubt, treat.’’ A combination of antidepressant medication, supportive psychotherapy, and patient and family education are the gold standard of treatment for depression in advanced disease. Several randomized, controlled trials that compared antidepressants with a placebo for depression in cancer patients suggested a benefit from treatment...

Serotonin-specific reuptake inhibitors (SSRI) are the first-line agents when life expectancy is 2-3 weeks or more, and they are safe and well tolerated in cancer patients. They are especially useful for depression with irritability and/or comorbid anxiety.

To avoid initial side effects, oncologists should prescribe a starting dose for 4-7 days, then increase to the normal dose. Educate the patient that antidepressants take about 2 weeks for initial response and 4-6 weeks to reach peak effect at a given dose.

If the patient obtains a partial response after 1 month on a normal dose, increase to a higher dose to get a complete response. If the patient shows little or no response, switch to another agent.

Patients who fail 2 different SSRIs, or obtain only a partial response, should be referred to a psychiatrist for further evaluation and treatment.

JE Bower. Behavioral symptoms in patients with breast cancer and survivors. J Clin Oncol 2008;26(5):768-77.

The majority of studies find that 20% to 30% of women experience elevated depressive symptoms, although the prevalence of major depressive disorder may be considerably lower. Major depressive disorder is a clinical syndrome that lasts for at least 2 weeks and causes significant impairment in normal functioning.

One recent study that used a structured clinical interview to diagnose depression found that 9% of ambulatory breast cancer patients met criteria for major depression. Psychological distress and depressive symptoms are typically highest in the first 6 months after cancer diagnosis and then decline over time as women adjust to the initial shock of diagnosis and acute effects of cancer treatment...

As might be expected, depression has a detrimental effect on all aspects of quality of life in cancer patients and is associated with poorer medical adherence and more barriers to cancer care, including lack of understanding of treatment recommendations and worries about treatment adverse effects.

There is also evidence of increased morbidity and, possibly, mortality in depressed cancer patients. As such, depression represents an important target for timely identification and treatment.

L Corbin. Safety and efficacy of massage therapy for patients with cancer. Cancer Control 2005;12(3):158-64.

Conventional care for patients with cancer can safely incorporate massage therapy, although cancer patients may be at higher risk of rare adverse events. The strongest evidence for benefits of massage is for stress and anxiety reduction, although research for pain control and management of other symptoms common to patients with cancer, including pain, is promising.

The oncologist should feel comfortable discussing massage therapy with patients and be able to refer patients to a qualified massage therapist as appropriate.

WA Mellink et al. Cancer patients seeking a second surgical opinion: Results of a study on motives, needs, and expectations. J Clin Oncol 2003;21(8):1492-7.

In 212 consecutive patients seeking a second opinion at the Surgical Oncology Outpatient Clinic, satisfaction with the first specialist, motivation for the second opinion, need for information, preference for decision participation, and hope for and expectation of a different second opinion were assessed with a questionnaire...

The mean age was 53 years. Most patients were women (82%), of whom 76% were diagnosed with breast cancer. Half of the patients (51%) had a low educational level. The majority of patients (62%) only had internal motives for second-opinion seeking associated with the need for reassurance and more certainty, whereas a substantial minority of patients (38%) also had external motives related to negative experiences or unfulfilled needs.

The externally motivated patients had a higher anxiety disposition, were less satisfied with their first specialist, preferred a more active role in medical decision making, and more often hoped for and expected a different second opinion.

N Moumjid et al. Seeking a second opinion: Do patients need a3 second opinion when practice guidelines exist? Health Policy 2007;80(1):43-50.

Patients often search for a second opinion (ie, a search for additional information on the diagnosis and/or treatment options and the potential prognosis, which will help the patient decide what to do or not to do, where, with whom and how). The scope of this phenomenon is not well documented. Also it is not clear if this is warranted or not.

This paper aims to explore whether knowing that his clinician follows practice guidelines eliminates the need of a patient’s to seek a second opinion. Given that practice guidelines should allow each patient to benefit from the best current clinical evidence, one might wonder if in such a context a second opinion is still necessary, and if so, for what reasons? ...

We conclude that the implementation of practice guidelines will not eliminate the need for a second opinion consultation. On the contrary, the use of guidelines can even stimulate a broader request for second opinions.

Select Publications