What are the mental disturbances associated with pancreatic (pancreas) tumors?

From the Guidelines

Pancreatic tumors can cause significant mental disturbances, and the most effective approach to managing these symptoms is a stepped-care model, offering the most effective and least resource-intensive intervention based on symptom severity, as recommended by the most recent guideline update 1. The mental disturbances associated with pancreatic tumors result from multiple factors, including inflammatory cytokines released by the tumor, metabolic disturbances from pancreatic dysfunction, and psychological reactions to diagnosis and symptoms.

• Depression is a common symptom, affecting up to 50% of patients, and can be treated with cognitive behavior therapy (CBT), behavioral activation (BA), or empirically supported psychosocial interventions, as well as pharmacologic regimens such as SSRIs (sertraline 50-200mg daily or escitalopram 10-20mg daily) for patients who do not have access to first-line treatment or prefer pharmacotherapy 1.
• Anxiety can be treated with CBT, BA, structured physical activity, acceptance and commitment therapy, or psychosocial interventions, and benzodiazepines (lorazepam 0.5-2mg as needed) may be used for acute anxiety.
• Pain management is also crucial, as uncontrolled pain worsens mental health symptoms, and patients should be monitored for suicidal ideation, as the suicide risk is higher in pancreatic cancer than other malignancies.
• Early psychiatric consultation is recommended as part of comprehensive care, and family members should be educated about these mental health aspects to provide better support and recognize warning signs requiring intervention, as suggested by the American Society of Clinical Oncology clinical practice guideline 1. Key considerations in managing mental disturbances in pancreatic tumor patients include:
• Assessing symptom severity and using a stepped-care model to provide the most effective and least resource-intensive intervention
• Offering education regarding depression and anxiety to all oncology patients
• Providing access to psychological support through therapy and pharmacologic regimens as needed
• Monitoring for suicidal ideation and providing early psychiatric consultation as part of comprehensive care.

From the Research

Mental Disturbances in Pancreatic Tumor

• Mental disturbances such as depression and anxiety are common in patients with pancreatic cancer, with studies suggesting that these symptoms may occur in approximately 50% of patients before diagnosis is made 2.
• The etiology of depression in patients with pancreatic cancer may be linked to tumor-induced changes in neuroendocrine or acid-base systems, although confirmatory data are lacking 2.
• Depression and anxiety occur more frequently in patients with pancreatic cancer than in patients with other forms of cancer, and may be related to disruption in one of the physiologic functions of the pancreas, such as secretion of hormones, neurotransmitters, digestive enzymes, or bicarbonate 3, 4.
• In some cases, symptoms of depression and anxiety may precede knowledge of the diagnosis, raising speculation that mood and anxiety syndromes are related to the disease itself rather than just the prognosis or existential issues related to death and dying 3, 4.
• Treatment strategies for depression and anxiety in patients with pancreatic cancer include psychologic and pharmacologic interventions, and identification and treatment of these conditions is important for enhancing quality of life in this population 3, 5.

Biological Link between Depression and Pancreatic Cancer

• There appears to be a biological link between depression, anxiety, and pancreatic cancer, with some studies suggesting that depression may be a precursor to the disease 5.
• The exact mechanisms underlying this link are not fully understood, but may involve changes in hormone secretion, neurotransmitter function, or other physiologic processes 2, 5.

Psychological Stress in Pancreatic Cancer Patients

• Pancreatic cancer patients experience high levels of psychological stress, which can negatively impact their emotional and psychological well-being and interfere with their ability to cope with cancer symptoms and treatments 6.
• Qualitative studies have explored the experiences and perceptions of psychological stress reported by pancreatic cancer patients, and have identified the need for educational, spiritual, and social resources to address their emotional and psychological needs 6.