In complex cancer cases, tricky mental health issues often arise

Caleb Zimmerschied , Contributing News Writer

In a given year, the average U.S. adult has a 6.7 percent chance of experiencing a major depressive episode. With a cancer diagnosis, the likelihood of experiencing depression skyrockets. Rates of depression, for example, range from 22 to 57 percent for oropharyngeal cancer patients and between 33 to 50 percent for pancreatic cancer patients. Due to the complexity of the experiences patients have during and following cancer diagnosis and treatment, it is important for clinicians to respond to their physical and psychological vulnerabilities.

This month’s AMA Journal of Ethics® explores ethical questions about psycho-oncology and the clinical and policy-level challenges of integrating mental health care into cancer care. This issue considers how physicians can approach patients, interact with surrogates or family members, and integrate mental health screening more fully into cancer care

Take a moment to consider this question: A grieving widow with breast cancer says she doesn’t want to continue treatment. How should her oncologist respond?

  • Refer her to a psychiatrist.
  • Test her decisional capacity.
  • Seek more information from her family.
  • Respect her decision to decline cancer treatment.

Give your answer and find responses to this question in the May issue of the AMA Journal of Ethics. 

Articles include:

Influence of Psychiatric Symptoms on Decisional Capacity in Treatment Refusal.” How should physicians weigh a patient’s psychiatric symptoms in assessing a patient’s decision-making capacity? This article considers the case of a grieving patient who refuses cancer treatment, reviewing the conceptual model of informed consent and discussing strategies for evaluating decisional capacity.

Do Pediatric Patients Have a Right to Know? If a patient lacks cognitive capacity, to what extent should they participate in medical decisions? This article considers whether minors’ “right to know” supersedes the wishes of parents who want to shield their children from crucial information.

“Ethical Management of Patients with Cancer and Mental Illness.” Cancer patients with a co-existing mental illness are particularly vulnerable due to their compromised ability to understand their diagnosis, prognosis, and treatment plan. Factors arising from their mental illness also contribute to an increased mortality rate among psychiatric patients. This case and article explore strategies for providing just and compassionate care to these patients.

“Prioritizing Mental Health Research in Cancer Patients and Survivors.” Despite indications from previous studies that psychological disorders are especially common in cancer patients and may significantly affect these patients’ overall morbidity and mortality, very little funding is devoted to mental health research among cancer patients and survivors. With the number of cancer survivors projected to rise dramatically, this article reviews the importance of dedicating additional money to this under-researched area.

In the AMA Journal of Ethics May podcast, issue editor and third-year medical student Weisheng Renee Mao interviews expert Tarris Rosell, PhD, DMin, MDiv, about the importance of spiritual-care referrals for cancer patients.

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care.

The Conley ethics essay and art of medicine contests are now open for students, residents and fellows, with $3,000 prizes for winning essays with up to two $1,000 honorable mentions.

The June issue of the AMA Journal of Ethics will focus on moral distress and medicine. Sign up to receive email alerts when new issues are published.