Depression in lung cancer patients.

Sir,

Lung cancer is one of the most common malignancies occurring in the world. Western literature describes varying rates (11-44% prevalence) of depression in patients with carcinoma of the lung.[12] Expensive prolonged therapy, lack of health insurance, low social and economic status, and low educational background are additional risk factors for the development of depression, especially in developing countries. Prevalence of depression in lung cancer patients remains unexplored in developing countries like ours. Here, we report prevalence of depression in a cross-sectional sample these patients.

The sample included 100 consecutive patients with a biopsy-confirmed diagnosis of lung cancer who visited a Department of Pulmonology in a private tertiary care general hospital in Bengaluru, India, between September 2009 and October 2011. The diagnoses included adenocarcinoma, small cell carcinoma, large cell carcinoma, squamous cell carcinoma, and metastatic lung tumors. The Hamilton depression rating scale (HDRS) was administered to all patients. Patients with a score 7 or more were considered to be “cases” of depression.[3] HDRS has been shown to have good psychometric properties for screening of depression in cancer patients.[4] Study was approved by Institutional Ethics Committee.

There were 74 males and 26 females in our study. Mean age was 59.05 years (SD = 12.4). Mean HDRS score was 10 (SD = 1.6). The prevalence of depression was 28% (mild = 26%, moderate = 2%).

Recent proton magnetic resonance spectroscopy has shown that brain metabolism is altered in lung cancer patients even before initiation of treatment. Studies have also shown that inflammatory cytokines are elevated in these patients.[5] These changes might have an important role in alteration of cognitive functions and causation of depression.

Recent report from International Federation of Psycho-Oncology Societies reported that psycho-oncology is not well-established in a developing country and there is a need to enhance integration of psychological care with oncological care.[6] In order to plan such intervention there is a need for more research in this area. Our data adds to the existing literature on the prevalence of depression in cancer. Although prevalence in our sample is comparable to the developed world data, psycho-oncology care is neglected in our country.

Certain limitations should be kept in mind while interpreting this result. HDRS may not be good tool to assess depression in medically ill. In particular, loss of appetite, insomnia, fatigue, weight loss may be secondary to medical pathology rather than manifestation of depression. Further studies are needed to develop proper scale to evaluate depression in cancer patients.

This study brings to notice important clinical issue consultation liaison psychiatry. Further prospective studies are urgently needed to study depression in lung cancer. There is a need to establish robust clinical programs and research in psycho-oncology, especially in developing countries. Comprehensive psycho-oncology service wing establishment is required, especially in cancer care centers.