Psychiatric illness and psychosocial concerns of patients with newly diagnosed lung cancer

Abstract

Objective: To determine the nature and incidence of psychiatric illness, symptoms of potential psychiatric significance, substance abuse and psychosocial concerns among patients with newly diagnosed lung cancer.

Design: Case series.

Setting: Kingston Regional Cancer Centre, a tertiary care facility for ambulatory cancer patients.

Patients: Seventy-one consecutive English-speaking patients with recently diagnosed lung cancer undergoing radiotherapy or chemotherapy were asked to participate; 52 of the 57 patients who agreed were available for evaluation.

Outcome measures: Current and previous psychiatric diagnoses of affective, anxiety and adjustment disorders, and alcohol and tobacco abuse; symptoms of sadness, fear, shock, anger, denial, acceptance, guilt, suicidal ideation, thoughts of death, insomnia, loss of libido, impaired concentration and reduced level of work or interest; psychosocial concerns about family, work and finances; and an impression of coping.

Results: At the time of the interview two (4%) of the patients were found to have an affective disorder, none had an anxiety disorder, and six (12%) had an adjustment disorder. Previously, 16 patients (31%) had had an affective or anxiety disorder or both. Two (4%) had had an adjustment disorder following the diagnosis of their lung cancer that had resolved before the interview. At some point in their lives 24 patients (46%) had abused alcohol, and 7 (13%) were currently abusing alcohol. All had smoked, 33 (63%) having been tobacco dependent. Feelings of sadness were expressed by 23 (44%), fear by 15 (29%), anger by 2 (4%), shock by 9 (17%) and guilt by 4 (8%). Seven (13%) had considered suicide, and thoughts of death were reported by 16 (31%). Twenty (38%) were accepting of their diagnosis, and 5 (10%) expressed optimism. Twenty-seven (52%) had insomnia, which was reported to be severe by 15 (29%). Loss of libido was reported by 25 (48%) and was severe in 14 (27%). Difficulty concentrating was reported by 10 (19%) and a reduced ability to work or loss of interest by 17 (33%). Fifteen patients (29%) were concerned about their families and 4 (8%) about work or finances. Most (41 [79%]) had good family support, and 23 (44%) found support in religion. Seven patients (13%) seemed to be coping poorly.

Conclusions: Although psychiatric illness was infrequent, symptoms of potential psychiatric significance and psychosocial concerns were common in this patient population. Attention to these symptoms and concerns should be addressed in a systematic and effective way by all health care professionals and agencies planning the care of patients with lung cancer.