CoChat
Sign Up
Cited by 398Palliative and Oncologic CarePalliative Care and End-of-Life IssuesCancer survivorship and care

Depression and anxiety disorders in palliative cancer care

Open access
Wilson, Keith G., Chochinov, Harvey Max, Graham Skirko, Merika, Allard, Pierre, Chary, Srini, Gagnon, Pierre R., Macmillan, Karen, De Luca, Marina +4 more·2007·Journal of Pain and Symptom Management
DOI 10.1016/j.jpainsymman.2006.07.016
Open this paper in CoChat — free accountOpen PDF

Abstract

Depression and anxiety disorders are thought to be common in palliative cancer care, but there is inconsistent evidence regarding their relevance for other aspects of quality of life. In the Canadian National Palliative Care Survey, semi-structured interviews assessing depression and anxiety disorders were administered to 381 patients who were receiving palliative care for cancer. There were 212 women and 169 men, with a median survival of 63 days. We found that 93 participants (24.4%, 95% confidence interval=20.2-29.0) fulfilled Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for at least one anxiety or depressive disorder (20.7% prevalence of depressive disorders, 13.9% prevalence of anxiety disorders). The most frequent individual diagnosis was major depression (13.1%, 95% confidence interval=9.9-16.9). Comorbidity was common, with 10.2% of participants meeting criteria for more than one disorder. Those diagnosed with a disorder were significantly younger than other participants (P=0.002). They also had lower performance status (P=0.017), smaller social networks (P=0.008), and less participation in organized religious services (P=0.007). In addition, they reported more severe distress on 14 of 18 physical symptoms, social concerns, and existential issues. Of those with a disorder, 39.8% were being treated with antidepressant medication, and 66.7% had been prescribed a benzodiazepine. In conclusion, it appears that depression and anxiety disorders are indeed common among patients receiving palliative care. These disorders contribute to a greatly diminished quality of life among people who are dying of cancer.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.jpainsymman.2006.07.016

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Anxiety prevalence in palliative care is estimated at 14%.

    “whereas anxiety prevalence is estimated at 14%. 18”

    From Is Higher Acceptance Associated With Less Anticipatory Grief Among Patients in Palliative Care? (2017) · cites this paper as [18]

    The Prevalence of Depression and Anxiety Disorders section reports that 53 participants (13.9%) had an anxiety disorder, supporting the rounded 14% figure. The participants were receiving palliative care for cancer, so the study does not establish that prevalence across palliative care generally. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Depression is the most commonly diagnosed mental health disorder in palliative care, with estimates of 20%.

    “The most commonly diagnosed mental health disorder is depression, with estimates of 20%, 17,18”

    From Is Higher Acceptance Associated With Less Anticipatory Grief Among Patients in Palliative Care? (2017) · cites this paper as [18]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 75 · Cited by 398

Research works printed but not linked: 56

  1. Hotopf M, Chidgey J, Addington-Hall J, Ly KL. Depression in advanced disease: a systematic review Part 1. Prevalence and case finding. Palliat Med 2002;16:81e97.
  2. Wilson KG, Chochinov HM, de Faye BJ, Breitbart W. Diagnosis and management of depres- sion in palliative care. In: Chochinov HM, Breitbart W, eds. Handbook of psychiatry in pallia- tive medicine. New York, NY: Oxford University Press, 2000: 25e49.
  3. Harter M, Reuter K, Aschenbrenner A, et al. Psy- chiatric disorders and associated factors in cancer: results of an interview study with patients in inpa- tient, rehabilitation and outpatient treatment. Eur J Cancer 2001;37:1385e1393.
  4. Leopold KA, Ahles TA, Walch S, et al. Preva- lence of mood disorders and utility of the PRI- ME-MD in patients undergoing radiation therapy. Int J Radiation Oncol Biol Phys 1998;42:1105e1112.
  5. Stark DPH, House A. Anxiety in cancer patients. Br J Cancer 2000;83:1261e1267.
  6. Spitzer RL, Kroenke K, Linzer M, et al. Health-- related quality of life in primary care patients with mental disorders: results from the PRIME-MD 1000 study. JAMA 1995;274:1511e1517.
  7. Ciaramella A, Poli P. Assessment of depression among cancer patients: the role of pain, cancer type and treatment. Psychooncology 2001;10: 156e165.
  8. Ell K, Sanchez K, Vourlekis B, et al. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gyne- cologic cancer. J Clin Oncol 2005;23:3052e3060.
  9. Hopwood P, Stephens RJ. Depression in pa- tients with lung cancer: prevalence and risk factors derived from quality-of-life data. J Clin Oncol 2000;18:893e903.
  10. Spiegel D, Sands S, Koopman C. Pain and de- pression in patients with cancer. Cancer 1994;74: 2570e2578.
  11. Akechi T, Okamura H, Nishiwaki Y, Uchitomi Y. Psychiatric disorders and associated and predictive factors in patients with unresectable nonsmall cell carcinoma: a longitudinal study. Cancer 2001;92: 2609e2622.
  12. Chen M-L, Chang H-K. Physical symptom pro- files of depressed and nondepressed patients with cancer. Palliat Med 2004;18:712e718.
  13. Fainsinger RL, Nekolaichuk CL, Lawlor PG, et al. A multicenter study of the revised Edmonton Staging System for classifying cancer pain in ad- vanced cancer patients. J Pain Symptom Manage 2005;29:224e237.
  14. Nekolaichuk CL, Fainsinger RL, Lawlor PG. A validation study of a pain classification system for advanced cancer patients using content experts: the Edmonton Classification System for cancer pain. Palliat Med 2005;19:466e476.
  15. Jacobsen PB, Donovan KA, Weitzner MA. Distin- guishing fatigue and depression in patients with cancer. Semin Clin Neuropsychiatry 2003;8: 229e240.
  16. Wilson KG, Graham ID, Viola RA, et al. Struc- tured interview assessment of symptoms and con- cerns in palliative care. Can J Psychiatry 2004;49: 350e358.
  17. Bukberg J, Penman D, Holland JC. Depression in hospitalized cancer patients. Psychosom Med 1984;46:199e212.
  18. Kai-hoi Sze F, Wong E, Lo R, Woo J. Do pain and disability differ in depressed cancer patients? Palliat Med 2000;14:11e17.
  19. Breitbart W, Chochinov HM, Passik S. Psychiat- ric aspects of palliative care. In: Doyle D, Hanks GWC, MacDonald N, eds. Oxford textbook of palliative medicine, 2nd ed. New York: Oxford University Press, 1998: 933e954.
  20. Wilson KG, Chochinov HM, McPherson CJ, et al. Desire for euthanasia or physician-assisted sui- cide in palliative cancer care. Health Psychol, in press.
  21. Chatters LM, Levin JS, Taylor RJ. Antecedents and dimensions of religious involvement among older black adults. J Gerontol Soc Sci 1992;47: S269eS278.
  22. Markides KS. Aging, religiosity, and adjustment: a longitudinal analysis. J Gerontol 1983;38:621e625.
  23. Anderson F, Downing GM, Hill J. Palliative Per- formance Scale (PPS): a new tool. J Palliat Care 1996;12:5e11.
  24. Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky Performance Status Scale: an examina- tion of its reliability and validity in a research set- ting. Cancer 1984;53:2002e2007.
  25. Chochinov HM, Wilson KG, Enns M, et al. De- sire for death in the terminally ill. Am J Psychiatry 1995;152:1185e1191.
  26. Stewart AL, Teno J, Patrick DL, Lynn J. The con- cept of quality of life of dying persons in the context of health care. J Pain Symptom Manage 1999;17: 93e108.
  27. Chochinov HM, Hack T, Hassard T, et al. Dig- nity in the terminally ill: a cross-sectional cohort study. Lancet 2002;360:2026e2030.
  28. Wilson KG, Curran D, McPherson CJ. A burden to others: a common source of distress for the termi- nally ill. Cogn Behav Ther 2005;34:115e123.
  29. Spitzer RL, Williams JBW, Kroenke K, et al. Util- ity of a new procedure for diagnosing mental disor- ders in primary care: the PRIME-MD 1000 study. JAMA 1994;272:1749e1756.
  30. Jefford M, Mileshkin L, Richards K, et al. Rapid screening for depressiondvalidation of the Brief Case-Find for Depression (BCD) in medical oncol- ogy and palliative care patients. Br J Cancer 2004; 91:900e906.
  31. Chochinov HM, Wilson KG, Enns M, Lander S. Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judg- ments. Am J Psychiatry 1994;151:537e540.
  32. Endicott J. Measurement of depression in pa- tients with cancer. Cancer 1984;53:2243e2248.
  33. Patten SB. Progress against major depression in Canada. Can J Psychiatry 2002;47:775e779.
  34. Tweed DL, Blazer DG, Ciarlo JA. Psychiatric ep- idemiology in elderly populations. In: Wallace RF, Wolfson RF, eds. The epidemiologic study of the el- derly. New York, NY: Oxford University Press, 1994: 213e233.
  35. Klapow J, Kroenke K, Horton T, et al. Psycholog- ical disorders and distress in older primary care pa- tients: a comparison of older and younger samples. Psychosom Med 2002;64:635e643.
  36. Koenig HG, George LK, Titus P. Religion, spiri- tuality, and health in medically ill hospitalized older patients. J Am Geriatr Soc 2004;52:554e562.
  37. Koenig H, Pargament KI, Nielsen J. Religious coping and health outcomes in medically ill hospi- talized older adults. J Nerv Ment Dis 1998;186: 513e521.
  38. Braam AW, van den Eeden P, Prince MJ. Reli- gion as a cross-cultural determinant of depression in elderly Europeans: results from the EURODEP collaboration. Psychol Med 2001;31:803e814.
  39. Penninx BWJH, van Tilburg T, Boeke AJP, et al. Effects of social support and personal coping re- sources on depressive symptoms: different for vari- ous chronic diseases? Health Psychol 1998;17: 551e558.
  40. Hann D, Baker F, Dennison M, et al. The influ- ence of social support on depressive symptoms in cancer patients: age and gender differences. J Psy- chosom Res 2002;52:279e283.
  41. Hildebrandt MG, Stage KB, Kragh-Soerensen P. Gender and depression: a study of severity and symptomatology of depressive disorders (ICD-10) in general practice. Acta Psychiatr Scand 2003;107: 197e202.
  42. Williams JB, Spitzer RL, Linzer M, et al. Gender differences in depression in primary care. Am J Ob- stet Gynecol 1995;173:654e659.
  43. DeFlorio M, Massie MJ. Review of depression in cancer: gender differences. Depression 1995;3: 66e80.
  44. Kirsh KL, McGrew JH, Passik SD. Difficulties in screening for adjustment disorder, Part II: an at- tempt to develop a novel self-report screening in- strument in cancer patients undergoing bone marrow transplantation. Palliat Support Care 2004; 2:33e41.
  45. Lynch ME. The assessment and prevalence of affective disorders in advanced cancer. J Palliat Care 1995;11:10e18.
  46. Derogatis LR, Morrow GR, Fetting J, et al. The prevalence of psychiatric disorders among cancer patients. JAMA 1983;249:751e757.
  47. Razavi D, Delvaux N, Farvacques C, et al. Screening for adjustment disorders and major de- pressive disorders in cancer in-patients. Br J Psychi- atry 1990;156:79e83.
  48. Cohen SR, Mount BM, Bruera E, et al. Validity of the McGill Quality of Life Questionnaire in the palliative care setting: a multi-centre Canadian study demonstrating the importance of the existential do- main. Palliat Med 1997;11:3e20.
  49. Beekman ATF, de Beurs E, van Balkom AJLM, et al. Anxiety and depression in later life: co-occur- rence and communality of risk factors. Am J Psychi- atry 2000;157:89e95.
  50. Lenze EJ, Mulsant BH, Shear MK, et al. Comor- bid anxiety disorders in depressed elderly patients. Am J Psychiatry 2000;157:722e728.
  51. Rush AJ, Zimmerman M, Wisniewski SR, et al. Comorbid psychiatric disorders in depressed outpa- tients: demographic and clinical features. J Affect Disord 2005;87:43e55.
  52. Zimmerman M, Chelminski I. Generalized anx- iety disorder in patients with major depression: is DSM-IV's hierarchy correct? Am J Psychiatry 2003; 160:504e512.
  53. Saunders C. The evolution of palliative care. Pa- tient Educ Couns 2000;41:7e13.
  54. Lloyd-Williams M, Friedman T, Rudd N. A sur- vey of antidepressant prescribing in the terminally ill. Palliat Med 1999;13:243e248.
  55. Sharpe M, Strong V, Allen K, et al. Major de- pression in outpatients attending a regional cancer centre: screening and unmet treatment needs. Br J Cancer 2004;90:314e320.
  56. Hirai K, Morita T, Kashiwagi T. Professionally perceived effectiveness of psychosocial interven- tions for existential suffering of terminally ill cancer patients. Palliat Med 2003;17:688e694.

Authors
Wilson, K. G., Chochinov, H. M., Graham Skirko, M., Allard, P., Chary, S., Gagnon, P. R., Macmillan, K., De Luca, M., O'Shea, F., Kuhl, D., Fainsinger, R. L., & Clinch, J. J.
Affiliations
Ottawa Hospital (CA)
Corresponding author
Wilson, Keith G.
ORCID
Venue
Journal of Pain and Symptom Management
Publisher
Elsevier BV
Published
2007-02
Volume
33
Issue
2
Pages
118-129
ISSN
0885-3924 (ISSN-L)
DOI
10.1016/j.jpainsymman.2006.07.016
OpenAlex
W1981592659
Cited by
398
References
75
Citations by year
2026: 10 · 2025: 10 · 2024: 16 · 2023: 19 · 2022: 32 · 2021: 29 · 2020: 22 · 2019: 23 · 2018: 21 · 2017: 21 · 2016: 11 · 2015: 11 · 2014: 21 · 2013: 32 · 2012: 30
FWCI
20.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Pain and Symptom Management (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Canadian Institutes of Health Research
  • National Cancer Institute (Tier 1)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
Keywords
depression, anxiety disorders, palliative care, cancer, quality of life, prevalence, comorbidities, performance status, social networks, religious participation, somatic symptoms, existential concerns, antidepressants, benzodiazepines, end-of-life care
MeSH terms
Aged, Aged, 80 and over, Anxiety Disorders, Depressive Disorder, Female, Humans, Male, Middle Aged, Neoplasms, Palliative Care, Comorbidity, Prevalence

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review