Objective: To survey changes in depressive symptoms over time in patients with advanced cancer using the Mood Evaluation Questionnaire (MEQ), and explore how effective Palliative Care Professionals (PCPs) are at assessing this.
Method: Forty-five advanced cancer patients were followed monthly for up to six interviews (108 interviews in total). Selected clinical variables were recorded.
Results: At first interview, 26 (58%) patients were depressed using MEQ, seven (16%) severely. Attrition rates were high, with 28, 13, nine, seven and six patients available for subsequent interviews. A > 12-point increase in MEQ over sequential interviews was associated with reduced survival (Hazard ratio 3.2, CI 1.2–8.4). PCPs recognized depressed mood, but underdiagnosed severe depression in 9% of patients (CI 3–16%, P = 0.002). A past history of depression was a strong indicator of current depressed mood on the MEQ.
Conclusion: Change in depressive symptoms over time is related to mortality in this patient cohort, patients with marked deterioration in mood dying earlier. PCPs usually recognize patients' depression but underestimate the severity of depressed mood.
Meyer HAM, Sinnott C, Seed PT. Depressive symptoms in advanced cancer. Part 1. Assessing depression: the Mood Evaluation Questionnaire. Palliat Med2003; 17.
2.
Maguire P. Barriers to psychological care of the dying. Br Med J1985; 291: 1711–1713.
3.
Altman DG. Practical statistics for medical research. London: Chapman and Hall, 1990.
4.
McDonald MV, Passik SD, Dugan W, Rosenfeld B, Theobald DE, Edgerton S. Nurses recognition of depression in their patients with cancer. Oncol Nurs Forum1999; 26: 593–599.
5.
Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S. Oncologists' recognition of depression in their patients with cancer. J Clin Oncol1998; 16: 1594–1600.
6.
Maguire P. Managing psychological morbidity in cancer patients. Eur J Cancer2000; 36: 556–558.
7.
Maguire P, Faulkner A, Booth K, Elliot C, Hillier V. Helping cancer patients disclose their concerns. Euro J Cancer1996; 32: 78–81.
8.
Chochinov HM, Wilson KG, Enns M, Mowchun N, Lander S, Levitt M, Clinch JJ. Desire for death in the terminally ill. Am J Psychiatry1995; 152: 1185–1191.
9.
Carson AJ, Best S, Warlow C, Sharpe M. Suicidal ideation among outpatients at general neurology clinics: prospective study. Br Med J2000; 320: 1311–1312.
10.
Hinton JM. The physical and mental distress of the dying. Q J Med NS1963; 32: 1–21.
11.
Hinton JM. The psychiatry of terminal illness in adults and children. Proc R Soc Med1972; 65: 29–34.
12.
Kent JM. SnaRIs, NaSSAs, and NaRIs: new agents for the treatment of depression. Lancet2000; 335: 911–918.
13.
Thompson C. Mirtazapine versus selective serotonin reuptake inhibitors. J Clin Psychiatry1999; 60 (suppl 17):18–22.
14.
Olin J, Masand P. Psychostimulants for depression in hospitalised cancer patients. Psychosomatics1996; 37: 57–62.
