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Minerva Psichiatrica 2008 June;49(2):129-43


language: English

The assessment and treatment of distress in cancer patients: overview and future directions

Lo C. 1, 2, Li M. 1, 2, Rodin G. 1, 2

1 Behavioural Sciences and Health Research Division Toronto General Research Institute University Health Network, Toronto, Canada 2 Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital and Psychosocial Oncology and Palliative Care Research Division Ontario Cancer Institute University Health Network, Toronto, Canada


Cancer is uniformly associated with distress at all points in the disease trajectory. There has been increasing awareness of the need to identify, prevent, and treat such distress, although evidence is still accumulating regarding the benefit of specific interventions. The clinical presentations of distress on a continuum from non-pathological sadness to major depression are discussed, and the issues surrounding its assessment and treatment are reviewed. Recent research provides modest support for the benefit of both psychosocial and pharmacological interventions, although further study is needed to evaluate the impact of routine distress screening and triage for psychosocial care. Data is presented to support a multifactorial model for the emergence of distress and recommendations are made regarding future directions for research in this area. These include the development of more tailored interventions with attention to specific characteristics and needs of patients and families and to potential biological contributors to distress. Efforts to prevent and relieve distress at all stages of the disease are important in order to reduce suffering and preserve quality of life in patients with cancer. Such approaches are most likely to be effective if they are implemented early in the disease trajectory and integrated with palliative and routine cancer care. Their widespread implementation may require newer and novel means of treatment delivery, which include group interventions, telephone counselling, and the use of the internet. However, attention to distress in patients with cancer and other medical conditions may help to ensure that the care that is delivered is comprehensive and patient-centered, with patient wellbeing and quality of life as central outcomes.

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