Management of emotional distress in cancer patients: is there a role for antidepressants?

Introduction Depression is common in cancer patients and often associated with increased morbidity, hospitalisation and reduced quality of life. Current opinion supports the use of antidepressants (AD) for moderate and severe depression in physical illness. However, AD may be inadequately prescribed to oncology patients and factors other than need may influence prescribing practice. Aims To explore oncology professionals views on the use of AD in the management of emotional distress in cancer patients. Methods 18 randomly selected professionals from the Yorkshire Cancer Network (oncologists, surgeons, clinical nurse specialists and ward nurses) participated in a qualitative interview study. To explore their views on AD use in oncology they were asked: What leads you to prescribe AD? or Do you have any views on the use of AD? key themes were extracted via framework analysis. Results Despite recognising the value of AD in cancer care, professionals were reluctant to prescribe AD stressing a lack of knowledge I would be very worried about my ability to do that and overwhelmingly saw the general practitioner (GP) as most appropriate for this role. Overreliance on AD was voiced as were views that taking AD was defeatist medicating them is a slippery slope. Conclusion These findings highlighted a need for training on the use of AD in cancer care and to counteract negative views contributing to exclusion from treatment plans. A key prescribing role for the GP is described however it is unclear whether referrals are made. Future work should determine the role of the GP and map prescribing patterns elsewhere.