Clinical Review ABC of psychological medicine


BMJ 2002; 325 doi: (Published 17 August 2002) Cite this as: BMJ 2002;325:377
  1. Craig A White,
  2. Una Macleod

    Cancer is the most feared of diseases. Unsurprisingly, it causes considerable psychological distress in patients, families, carers, and often those health professionals who care for them. Only a minority of cancer patients develop psychiatric illness, but other psychologically and socially determined problems are common. These include unpleasant symptoms such as pain, nausea, and fatigue; problems with finances, employment, housing, and childcare; family worries; and existential and spiritual doubts. Well planned care that fully involves patients and their families can minimise these problems.

    Embedded Image

    Squamous cell cascinoma on lip after radiotherapy. As well as the fear of cancer itself, an additional source of distress can be the potentially disfiguring nature of the disease and its treatment

    Psychological consequences

    Though often dismissed as “understandable,” distress is a treatable cause of reduced quality of life and poorer clinical outcome. Some patients delay seeking help because they fear or deny their symptoms of distress. Presentation can be obvious, as depressed or anxious mood can manifest as increased severity of somatic complaints such as breathlessness, pain, or fatigue. Adjustment disorder is the commonest psychiatric diagnosis, and neuropsychiatric complications may occur. The risk of suicide is increased in the early stages of coping with cancer.


    Depression is a response to perceived loss. A diagnosis of cancer and awareness of associated losses may precipitate feelings similar to bereavement. The loss may be of parts of the body (such as a breast or hair), the role in family or society, or impending loss of life. Severe and persistent depressive disorder is up to four times more common in cancer patients than in the general population, occurring in 10-20% during the disease.

    “Distress is an unpleasant emotional experience of a psychological, social, or spiritual nature that may interfere with a patient's ability to cope with cancer and its treatment. Distress extends along …

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