NEW YORK--Patients terminally ill with cancer who seek a hastened death may be suffering from hopelessness with an overlay of severe depression.
A psychiatry group at Memorial Sloan-Kettering Cancer Center here, looking to find out why some terminally ill patients want to hasten death and others don't, reported in the Dec. 13 JAMA that it found hopelessness and depression to be independent and distinct factors that can be lethal alone or in combination.
In a study of 92 patients at the Calvary Hospital, a hospice in the Bronx, Dr. William Breitbart and colleagues, using a self-reporting scale they have developed to measure a hastened desire for death, found that patients with a major depression were four times more likely to have a high desire for a hastened death (47% vs. 12%). Patients rated as having hopelessness were nearly twice as likely to have such a desire.
Hopelessness was characterized as "a pessimistic cognitive style rather than an assessment of one's poor prognosis." The team said it found that nearly 25% of patients who suffered from hopelessness or depression had a high desire for hastened death, as did nearly two-thirds who had both. Conversely, no patient who was free of depression or hopelessness had such a desire.
There was no link between the cancer patients' pain and the desire for a hastened death, similar to other studies' findings, but the authors noted that the hospice has a first-rate pain-management program.
Noting a need to devise therapy for terminal cancer patients who express a desire for a hastened death, the team conceded that while depression can be managed there are no known interventions for hopelessness in the absence of depression. The investigators called the diagnosis of hopelessness "an important new frontier in palliative care."
In an interview, Dr. Breitbart estimated that perhaps 5% of cancer patients seeking a hastened death suffer from neither depression nor hopelessness as defined in his study. Yet he believes these attitudes, if treated properly, are remediable even if they are not irrational or pathological by definition.
Nevertheless, he added, few hospices or hospital palliative-care services have a psychiatrist as part of their multidisciplinary teams--a serious deficiency, he believes.