Mental Health Examination in Newly Diagnosed Lung Cancer Patients
A comprehensive biopsychosocial assessment is recommended for all patients newly diagnosed with lung cancer, to be performed soon after diagnosis and at key transition points throughout the remainder of life. 1
Initial Assessment Components
Screening for Psychological Distress
- Evaluate for depression, anxiety, excessive daytime sedation, and fatigue 1
- Screen for suicidal ideation - higher risk in patients who are:
- Male
- Older
- Experiencing unrelieved pain
- Physically dependent
- Lacking social support
- Showing cognitive impairment 1
Common Psychological Symptoms to Assess
- Depression (affects approximately 33% of patients with inoperable lung cancer) 2
- Anxiety (particularly high in younger patients and those with metastatic disease) 3
- Insomnia (one of the most common symptoms in newly diagnosed patients) 1
- Fatigue (ranked as the most severe symptom during treatment) 1
Recommended Screening Tools
- Hospital Anxiety and Depression Scale (HADS) - shown to be most suitable for screening psychiatric disorders in both lung cancer patients and their partners 4
- Distress Thermometer - though less suitable than HADS for identifying psychiatric disorders 4
Timing of Assessments
- Initial assessment: Soon after diagnosis 1
- Follow-up assessments at key transition points:
- Completion of treatment
- Disease progression
- New symptom onset 1
Intervention Approach
For Identified Psychological Symptoms
- Address symptoms with appropriately trained individuals 1
- Develop a comprehensive symptom management plan that includes:
- Non-pharmacologic interventions
- Medication management 1
Pharmacological Interventions
- For depression and anxiety: Antidepressants and anxiolytics 1
- For excessive daytime sedation and fatigue: Psychostimulants 1
- For insomnia: Sedating antidepressants preferred over sedative-hypnotics (they target both sleep and mood) 1
Non-Pharmacological Interventions
For psychological distress, consider evidence-based interventions:
- Psycho-education
- Deep breathing
- Progressive muscle relaxation
- Guided imagery
- Cognitive behavioral therapy
- Supportive psychotherapy 1
Special Considerations
Risk Factors for Depression
- Functional impairment (most important risk factor - depression increases by 41% for each increment on impairment scale) 2
- Pretreatment physical symptom burden
- Fatigue
- Poor clinician-rated performance status 2
- Small-cell lung cancer patients (three times higher depression rates than non-small-cell) 2
Risk Factors for Anxiety
- Female gender
- Age under 65
- Metastatic disease
- Poor performance status 3
Breathlessness Management
- For patients experiencing breathlessness, implement interventions specifically designed to manage this symptom using:
- Psychological coping strategies
- Physical adaptation techniques 1
- These targeted interventions more effectively decrease distress than usual care provided during follow-up visits 1
Implementation Considerations
- Health care systems should develop and support integrated programs in psychological and physical symptom management accessible to all cancer patients 1
- Healthcare professionals should receive specific training in psychological and physical symptom management 1
- Family support should be considered, as cancer diagnosis affects partners and family members 5
Pitfalls to Avoid
- Delaying psychological assessment until physical symptoms are severe
- Overlooking depression in patients with good performance status
- Failing to reassess at transition points in care
- Using only pharmacological approaches without integrating non-pharmacological interventions
- Providing complex information when patients are emotionally distressed 5
- Neglecting to screen partners who may also experience significant distress 4
Remember that approximately one in four persons with lung cancer experience periods of depression or other psychosocial problems during their illness 6, making mental health assessment and intervention an essential component of comprehensive cancer care.