Cheryl F. McCartney

Treatment of depression in cancer patients is associated with better life adaptation: a pilot study.

&NA; Major depression occurs in a significant number of cancer patients, and there is evidence that cancer patients with depression do not receive adequate antidepressant treatment. In an uncontrolled pilot study, the authors assess the degree of depression and the quality of life after the initiation of antidepressant medication treatment in 12 depressed cancer patients who received adequate antidepressant drugs and in 10 depressed cancer patients who received inadequate antidepressant treatment. These preliminary findings suggest that cancer patients with major depression benefit from antidepressant medication treatment and may experience an improved psychosocial adjustment to cancer. Controlled clinical trials will be necessary to verify these preliminary findings.

Quality of life in patients with gynecologic cancer

Benefits of cancer treatment must assess quality as well as quantity of survival. Recently, researchers have attempted to define and measure quality of life (QL). Reliable QL measures are useful for rating the QL costs of cancer itself, for rating existing cancer treatments and therapies under clinical investigation, and for evaluating the effectiveness of interventions to improve or prevent deterioration in QL status. Collaborative decision making by patients with their oncologists about anticipated therapy is enhanced by consideration of QL risks. Measures have broadened from assessing only performance status to include the domains of physical status (activity level, cognition, sexuality, fertility, and symptoms of pain, nausea, vomiting), psychological status (sense of well‐being, depression, anxiety), social interaction (with sexual partner, family, friends, and co‐workers), and economic status. Studies applying these concepts to patients who are survivors, in curative treatment, in palliative treatment, and terminally ill will be discussed.

The detection of depression by patient self-report in women with gynecologic cancer

We examined the utility of patient self-report forms in identifying those gynecologic oncology patients who would be diagnosed by an experienced consultation-liaison psychiatrist as suffering from major depression. Sixty-five women with gynecologic tumors were evaluated by a consultation-liaison psychiatrist, using standardized (DSM-III) criteria. Each patient also completed a Carroll Rating Scale for Depression (CRS). The CRS demonstrated sensitivity and specificity of 87 percent and 58 percent, respectively. Used as a screening instrument to rule out depression, the CRS yielded a negative predictive value of 94 percent. We identified a priori forty items from the CRS which should not be influenced by the non-psychiatric biologic effects of gynecologic tumors, and compared the performance of this non-cancer related symptoms subscale (NCSG) to that of the CRS. The NCSG did not significantly outperform the CRS; its sensitivity and specificity were 87 percent and 62 percent, respectively. Because our study population was relatively homogeneous (i.e., non-ovarian gynecologic oncology patients without severe debilitation who were not receiving chemotherapy, radiation therapy, or other invasive procedures), the findings should not be generalized to other oncologic populations at this time. Our results suggest that patient self-report forms can be effective screening devices for identifying those non-ovarian, gynecologic oncology patients who should then be carefully evaluated for coexisting clinical depression.

Decision by Single Women to Conceive by Artificial Donor Insemination

Single women are frequently denied artificial insemination with donor sperm (AID) by U.S. physicians. Reasons include the fear that any child lacking married parents will suffer psychological damage, the belief that an unmarried womans motivation is probably purely selfish, and the concern that single women will be unable to cope with the stresses of parenthood. Psychiatric interviews with 12 single applicants for AID were conducted to examine the validity of the latter two objections. The findings were then compared to Merritt and Steiners recent non-psychiatric descriptive study of 100 single mothers, almost all of whom either became pregnant by intercourse or adopted children.With AID, applicants sought to eliminate paternal obligations, emotional entanglements, and custody questions. All had given careful considerations to the demands of childrearing, social supports, finances, babysitting, and health insurance. They were unconcerned about social stigma associated with unwed pregnancy and motherhood...

Library collection of the psychosocial publications in consultation-liaison psychiatry

Psychiatric oncology is a relatively new area, and few comprehensive reviews of related subject matter are available. Thus, the psychiatrists at North Carolina Memorial Hospital who provide liaison to oncology saw the need for a collection of pertinent psychiatric oncology materials that could be studied by faculty, residents, and staff. Such materials would be valuable for patient consultation, lecture preparation, and research background. Their bibliography and library system are discussed here, with a description of the methods of its compilation. The unique features are referenced materials are filed in a centrally available location (departmental library), so that readers have immediate access to them, and bibliographic entries are stored in a small computer in the library, and can be retrieved by topic, title, author. The file currently holds over 340 articles, and is continuously updated. It has been extensively utilized by professionals in this tertiary care teaching hospital as well as in programs across the state.

Effect of Psychiatric Liaison on Consultation Rates and Reasons for Consult in Gynecologic Oncology

According to prevalence studies, about half of cancer patients have psychiatric disorders. However, only about 2% are referred for psychiatric consultation. Among gynecologic oncology patients, those with ovarian cancer may be particularly vulnerable to depression and anxiety because of their poor prognoses and stressful treatments. With a limited time series design, hospital chart review was used to examine the effect of adding a psychiatric liaison program to a pre-existing consultation service on (1) the overall rate of psychiatric consultation requests for gynecologic cancer patients, (2) the rate of consultations for the sub-group of ovarian cancer patients, and (3) the proportion of consults for ovarian cancer patients requested because of problems with depression and/or anxiety. With liaison there was a significant overall increase in consultation rate for gynecologic oncology patients. Liaison did not influence the consultation rate for ovarian cancer patients in that these patients had higher con...

Clinical Aspects of Neuropeptide Research

Increasing evidence suggests that depression is found in a high percentage of patients with cancer (Petty and Noyes 1981; Buckberg et al. 1984), but depression appears to be both underdiagnosed and inadequately treated in cancer patients. There is also a growing body of evidence suggesting that experimentally induced stress in animals as well as psychiatric illness and stressful life experience in humans are associated with alterations in both neuroendocrine and immune function. Alterations in immune function have been found in patients with major depression (Kronfol et al. 1983; Schliefer et al. 1984,1985), and there is one report suggesting an epidemiologic relationship between depression and cancer (Shekelle et al. 1981). However, it is not known whether the alterations in immune function found in depression are of clinical significance, and there have been no comprehensive studies of both neuroendocrine and immune function in depressed cancer patients.