Comparative studies of psychological function in patients with advanced cancer. II. Interviewer-rated current and past psychological symptoms.

This study compared psychologic function, especially depression, in patients with advanced cancer and in sociodemographically matched, physically healthy patients who had recently attempted suicide. A companion study examined self-report of depressive symptoms; the present study relied on a semistructured interview technique. Eighty patients who were hospitalized on a research oncology ward for treatment of disseminated cancer, acute leukemia, Stage IV Hodgkin's disease, or myeloma were compared by means of the Current and Past Psychopathology Scales (CAPPS) to 80 patients hospitalized on a psychiatric unit for attempted suicide. Interviewer ratings yielded scores on eight scales characterizing each patient's psychologic adjustment during the past month and 18 scales characterizing adjustment prior to the present illness (cancer or suicide attempt). Results showed that by both self-report and observer report, cancer patients wee less depressed and anxious in the past month than the psychiatric group. Approximately one-third on the cancer patients were significantly depressed, depending on the measure used; one-seventh had experienced some suicidal ideation. Cancer patients were better adjusted in the past than the comparison group; however, the cancer patients who were presently most depressed were those who had a prior history of depression and had shown a tendency to brood. Among cancer patients who died during the study period, no correlation between severity of depression and nearness to death could be found. Findings supported use of denial of dysphoric emotions by the cancer patients, but little denial of the diagnosis or the need to accept treatment. Despite stress of advanced illness and threat to life, cancer patient's reality testing and social role performance were superior to that of the suicide attempters, and on the average they had less disturbance of affect and cognition.