Affective and anxiety disorders in patients with cancer - Optimal management

Cancer, at all sites and stages (from early diagnosis to terminal phase), h as psychological effects in a significant number of patients. Diagnosis of depression and anxiety in this patient population can be difficult and must involve awareness of the symptoms and signs resulting from the cancer itse lf and antineoplastic therapies, and the differential diagnosis of 'functio n' and 'organic' mental disorders. When prescribing psychotropic medication s to patients with cancer, particular attention should be paid to drug inte ractions (e.g. the potential influence of psychoactive drugs on the metabol ism of chemotherapeutic agents). Despite provocative reports, it has to be acknowledged that to date, there is no evidence to substantiate the claim o f a negative impact of antidepressants on cancer initiation or prognosis. A lthough studies assessing the comparative effectiveness of psychopharmacolo gical agents are difficult to perform in patients with cancer, the efficacy and tolerability of several antidepressants and anxiolytics have been show n and a mixed approach, combining drug treatments and various forms of psyc hotherapy, is now widely encouraged. However, a lot of research remains to be conducted in order to better understand the specific relationships betwe en cancer and psychopathology, to identify risk factors and develop prevent ative strategies and to define a general model of treatment for psychiatric disturbances in patients with cancer.