When patients and family members have concerns about depression, they often bring them up with the staff, not with the treating oncologist.

“I think that people with cancer don’t want to distract their medical oncologist or their surgeon by talking about their mood,” Dr. Massie noted. “Some people are frankly embarrassed because they feel that having depression, low mood, or anxiety means that they are a lesser person.” Or they may assume that other patients with cancer are coping just fine, although sadness and anxiety are so common in patients with cancer, Dr. Massie said.

“Patients want their oncologists to focus on the cancer,” she continued. Just as patients don’t expect oncologists to spend time talking about finances or scheduling difficulties, they often don’t expect oncologists to spend time talking about emotions.

Spur and Refer

Staff members can spur conversation and refer patients to support groups. “We would hope the oncologist’s nurse or social worker can say to patients, ‘Let’s talk about your mood or your spirits. Has this been emotionally difficult for you? How are you holding up?’” Dr. Massie said. Staff members could reassure patients that they are not alone in experiencing anxiety and depression and need not be alone in addressing these issues.

Patients can be referred to emotional support groups or to a psychiatrist for individual counseling and/or antidepressant medication. Dr. Massie suggested that the treating oncologist consider starting the patient on an antidepressant, especially if there will be a wait to see a psychiatrist. ■