Psychiatric morbidity among cancer patients and its relationship with awareness of illness and expectations about treatment outcome

Sixty consecutive patients admitted to an oncology unit in a general hospital were systematically assessed to determine the prevalence of psychiatric disorders. Patients' awareness of the diagnosis of cancer and their perception of treatment intention and outcome were assessed independently by another investigator who was blind to the psychiatric diagnosis. Forty percent of the sample had a diagnosis of psychiatric disorder, based on the Diagnostic and Statistical Manual for Mental Disorders (3rd edition, revised). Adjustment disorders comprised most of the psychiatric diagnoses. Major depression was seen in 8 (13%) patients. One third of the patients were estimated to be unaware of the diagnosis of cancer, and 82% of patients perceived the treatment given as curative. Psychiatric morbidity was significantly less common in patients who did not know they had cancer, and in those who considered treatment as curative. The prevalence of depressive disorders in our sample was higher than in medical inpatients. It is concluded that psychiatric disorders, especially affective disorders, are common among cancer patients. Awareness of nature of the illness and expected outcome can affect the prevalence of psychiatric morbidity. Further studies investigating the relationship between psychiatric morbidity and duration of illness, type and stage of cancer, disabilities and coping strategies are warranted.