Akechi et al identified factors in patients with unresectable nonsmall cell lung carcinoma predictive of psychiatric distress. A patient with significant psychiatric distress may go unrecognized unless specifically looked for. The authors are from The National Cancer Hospital East in Chiba, Japan.


Forms of psychiatric distress:

(1) depression (depressive adjustment disorder or major depression)

(2) anxiety disorders (including phobias and panic disorders)

(3) alcohol abuse

(4) nicotine dependence in cigarette smokers


Factors associated with increased distress:

(1) uncontrolled pain

(2) moderate to severe physical disability

(3) history of depression and/or anxiety, especially at baseline (initial presentation)

(4) relatively young age (< 65 years)

(5) feeling hopeless and/or helpless


Factors associated with decreased distress:

(1) willingness to confide with the physician (and probably with others)

(2) social support

(3) radiotherapy (which can help control pain and disabling symptoms)


Smoking cessation was controversial, since on the one hand cessation improved dyspnea and cough, while on the other hand nicotine withdrawal symptoms contributed to distress. Either way there is significant distress to the patient.


Use of antidepressant and/or anxiolytic agents as needed should help to decrease psychiatric distress.


Interestingly depressive symptoms did not progress during the subsequent clinical course and can be reduced by attention to pain and the patient's other needs.


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