Psychological support and treatment of depression might be very important

Dr Marco Colleoni, European Institute of Oncology

Among people in hospital this rises to 22-24%.

Dr Marco Colleoni and colleagues from the European Institute of Oncology, Milan, Italy, assessed 39 patients who required psychological support after undergoing surgery for breast cancer.

The patients were compared with 78 other breast cancer patients who were better adjusted psychologically to their condition.

Only half of the depressed patients (51%) accepted follow-up chemotherapy compared with 92% of the control group.

Dr Colleoni said: "Our results indicate that depression represents a crucial factor for acceptance of adjuvant (follow-up) chemotherapy.

"Psychological support and treatment of depression might be very important to increase acceptance of chemotherapy and possibly improve the prognosis of these patients.

"In general, depressed patients, that are characterized by sense of helplessness, inadequacy and apprehension about cancer and cancer therapy, are highly concerned and troubled by the possible side effect of chemotherapy that includes nausea, vomiting, diarrhea, amenorrhoea and especially alopecia.

"They are concerned also about possible serious adverse event and morbidity related to chemotherapy."

Support groups

Dr Richard Sullivan, head of clinical programmes at the Cancer Research Campaign, said the best way to treat depression in cancer patients was to provide them with a supportive environment.

He suggested that hospitals set up support groups of former and current patients who were on hand to share their experiences.

He also said it was important that medical staff made time for patients and did not treat them in an offhand or cursory way.

"It is well known that it makes a big difference if people can be supported."

Dr Sullivan said anti-depressants should only be used as a last resort, and then only for selected patients.

There is a theory that surgery itself increases the risk that patients will develop depression.

The body reacts to surgery by releasing huge amounts of the hormones cortisol and adrenalin into the bloodstream.

This can depress the action of chemicals in the brain, leading to symptoms of depression.

Adjuvant chemotherapy in early breast cancer significantly improves the chances of a complete recovery.

Professor Amanda Ramirez, of the Imperial Cancer Research Fund's Psychosocial Oncology Group said: "This is a fascinating possibility and is intuitively appealing, but the methodology of the study is not always clear and more thorough prospective research is needed into the subject.

"Other studies using more reliable data have not found a link between depression and survival."

The research is published in The Lancet medical journal.