Role of a psychiatry liaison clinic in the management of breast cancer.

Psychological factors contribute to morbidity in the management of breast cancer. This study assesses the role of a psychiatric liaison clinic in the management of such problems. Fifty-seven patients with breast cancer seen by the liaison psychiatrist within the radiation oncology clinic from May 1989 to March 1991 were retrospectively reviewed. This population was assessed for pattern of referral, concordance between oncologist and psychiatrist regarding diagnosis, compliance with referral and treatment patterns. The most frequent times of referral were during initial treatment or at the time of metastatic or recurrent disease. Compliance with referral was 90%. There was concordance of psychiatric diagnosis between the oncologist and the psychiatrist in only 23%, with the oncologist failing to diagnose a major depression in a significant number of patients. Antidepressants were prescribed by the psychiatrist in all patients in whom a major depression was diagnosed. Our conclusions are that there is a high incidence of major depression in this outpatient breast cancer population. Oncologists frequently fail to recognize a major depression in this patient population with resultant psychological morbidity. Compliance with referral to a liaison psychiatric clinic located within an oncology department is high. The psychiatric management of these patients is an important part of their overall treatment.