Practice Clinical updates

Depression and anxiety in patients with cancer

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1415 (Published 25 April 2018) Cite this as: BMJ 2018;361:k1415
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Potential direct neuropsychiatric effects of specific tumour types and cancer treatments

  1. Alexandra Pitman, Macmillan consultant liaison psychiatrist, senior clinical lecturer in psychiatry1 2,
  2. Sahil Suleman, Macmillan consultant clinical psychologist, honorary research associate1 2,
  3. Nicholas Hyde, consultant head and neck surgeon1,
  4. Andrew Hodgkiss, consultant liaison psychiatrist, honorary clinical senior lecturer3 4 5
  1. 1St George’s University Hospitals NHS Foundation Trust, London, UK
  2. 2UCL Division of Psychiatry, London, UK
  3. 3Central & North West London NHS Foundation Trust, London, UK
  4. 4The Royal Marsden NHS Foundation Trust, London, UK
  5. 5Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
  1. Correspondence to: A Pitman a.pitman{at}ucl.ac.uk

What you need to know

  • Depression affects up to 20%, and anxiety 10%, of patients with cancer, compared with figures of 5% and 7% for past-year prevalence in the general population

  • Poor recognition of depression and anxiety is associated with reduced quality of life and survival

  • Some cancers, such as pancreatic and lung, can release chemicals that are thought to cause depression, and certain cancer treatments, such as chemotherapy and corticosteroids, are associated with depression

  • Depression in cancer patients receiving end-of-life care is no more prevalent than in patients living actively with cancer

  • Be aware that antidepressants can worsen existing cancer symptoms and interact with chemotherapy agents: sertraline and citalopram tend to have the least interactions and are generally well tolerated as first line agents

Advances in cancer treatments mean that half of people now diagnosed with cancer can expect to survive for at least 10 years,1 defining many cancers as long term conditions. Psychiatric illnesses such as depression and anxiety are common, but often neglected, complications of cancer, influencing quality of life, adherence to treatment, cancer survival, and treatment costs.23 Depression and anxiety affect up to 20% and 10% of patients with cancer respectively, regardless of the point in the cancer trajectory, and whether in curative or palliative treatment.4 Geographical variations in the diagnosis and treatment of depression or anxiety in cancer settings implies under-recognition of these problems.5 Depression is associated with poor adherence to cancer treatment and poor cancer survival,6 and the increased risk of suicide in all patients with cancer7 is a concern.

This clinical update outlines the prevalence, aetiology, and management of depression and anxiety in patients with cancer to raise awareness among doctors of the need to address the psychiatric consequences of cancer.

Sources and selection criteria

We conducted tumour-specific and treatment-specific PubMed searches, and used NICE …

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