Research findings on end-of-life cancer care do not paint an entirely bleak picture. Incurable cancer represents the paradigmatic existential crisis and thus an opportunity for individual reflection and interpersonal communion. Several promising lines of investigation have demonstrated the benefits of meaning-oriented psychological therapies and palliative care interventions on quality, and perhaps duration, of life for end-stage Inhibitors,research,lifescience,medical cancer patients.10-13 Taken together, these data suggest two important conclusions: (i) despite the widely held sentiment that depression is both an

unavoidable and “appropriate” response to the dying process, most terminal cancer patients do not meet diagnostic criteria for major depression but can still benefit from medical and psychosocial interventions; and (ii) depressive symptoms, when they do complicate terminal cancer care, warrant inhibitor ARQ197 accurate diagnosis and aggressive treatment to reduce the substantial suffering of these patients. This article reviews several ways in which depression impacts end-of-life Inhibitors,research,lifescience,medical care for adults with cancer. Specific topics include the Inhibitors,research,lifescience,medical diagnosis of depression in seriously ill cancer patients; the co-occurrence of depression and somatic symptoms;

the impact of depression on the course of illness; depression and decision-making capacity; suicide; desire for hastened death; treatment of depression in patients with advanced cancer; and recent research in palliative care that is relevant to depression at the end of life. Diagnosis of depression

in patients with advanced cancer Optimum end-of-life care for cancer patients requires an ability to make an accurate diagnosis of depression. The frequency with which depression is both underdiagnosed (eg, Inhibitors,research,lifescience,medical dismissed as a normal and anticipated response to illness or not considered at all) and misdiagnosed (eg, mistaken for delirium or poorly controlled pain) in the Inhibitors,research,lifescience,medical oncology setting is a manifestation of the clinical complexity of patients dying from cancer.14 The patient with widely metastatic cancer who is enduring chemotherapy and radiation treatment Drug_discovery is more likely than not to www.selleckchem.com/products/Dasatinib.html experience sleep disturbance, fatigue, anorexia, and weight loss, whether a depressive syndrome is present or absent. Whereas the failure to recognize depression can result in needless suffering, misdiagnosis can cause avoidable harm by means of inappropriate pharmacological treatment. The most frequent and consequential example of this diagnostic and pharmacological mismanagement is delirium. Hypoactive delirium is the most common subtype of delirium, and particularly likely to be mistaken for depression.15-21 Prescribing an antidepressant or a psychostimulant to a patient who is withdrawn as a result of delirium, rather than depression, is more likely to exacerbate the delirium than alleviate depressive symptoms.