FCRP Policy Statement

Research suggests that the recognition and treatment of depression enhances quality of life, reduces the degree of pain and disability experienced by chronically ill patients, and improves the outcome of the medical condition. Patients and physicians often mistakenly believe that "it's normal to be depressed when you have cancer." This sort of belief leads to a "don't ask-don't tell" relationship between patient and physician. The patient is then left to cope with mental and emotional stress that might otherwise have been mediated or avoided had open discussion been encouraged and the treatment of depression been provided.

The experience of depression can lead to severe emotional and physical effects (e.g., fatigue, insomnia) which occur along with and magnify the effects of the illness itself or its treatment. Clinical depression frequently occurs together with a number of other disorders (e.g., cancer, Alzheimer's disease). Depression is a common reaction to severe physical conditions, but clinical depression is not merely a reaction-it is an illness for which treatment should be considered. When clinical depression co-occurs with other medical and psychiatric disorders and when treatment is not undertaken, the overall effect may be increased impairment and decreased improvement.

The under-treatment of cancer pain is a serious and neglected public health problem. A recent study by researchers at Michigan State University assessed the relationship of pain and depression among cancer patients receiving therapy for their disease. Previous research has shown a relationship between pain and depression, but has not provided adequate information on the relationship between the two. MSU researchers found that the prevalence of depression in cancer patients exceeds that found in the general population. Although it is difficult to discern whether or not pain is a direct cause of depression, as the effects of age, gender, physical limitations, and social support all can affect the depression a cancer patient experiences, it is known that both clinical depression and pain are treatable conditions.

Depression must be seriously considered in the treatment of a t\patient with a life-threatening chronic illness which presents a multiplicity of symptoms. Under-treatment of symptoms and mismanagement of pain has led to an increased public acceptance of assisted suicide. As more and more individuals approve of and support the legalization of assisted suicide, the role of health professionals is seen less as providing adequate and appropriate health care and more as providing a swift, painless death to those suffering a debilitating disease. Although patients who are dying should not undergo unnecessary suffering, pain management medication does exist and should be prescribed (please see the Agency for Health Care Policy and Research guidelines on cancer pain and depression). Likewise, those suffering from depression could be greatly helped by the use of certain types of medication and by counseling and guidance. Unfortunately the health care system that exists today is not designed to meet such needs, and assisted suicide is a direct reflection of this. Misinformed beliefs about addiction held by patients and health care professionals and fears of abuse of regulations often prohibit the use of pain- and depression-relieving treatments.

Policy Implications

• Programs for health care professionals must be created and implemented to educate nurses and physicians of the appropriate use of anti-pain and anti-depressant treatment strategies.
• Easing the discomfort, pain, and symptoms of patients with chronic disease must be a priority; treatment goals must be redirected to meet quality of life goals. The person comes first in treatment-it is not enough to merely treat the disease.
• Community groups which strive to dispel stereotypes about addiction and to educate individuals about pain and depression management and appropriate treatment must be supported by local, state, and federal funds.

From: Stommel, M., Ogle, K. S., Dwyer, L. V., Given, B. & C. W. (1996). The relationship of pain and depression among cancer patients residing at home. Manuscript submitted to Health Psychology. Research supported by the Rural Partnership Linkage for Cancer Care project, grant #RO1 CA56338 from the National Cancer Institute, Barbara A. Given, Principal Investigator.