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Cancer-related Depression — SCE Medical Oncology MCQ

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EasySupportive & Palliative OncologyCancer-related DepressionSCE Medical Oncology

A 60-year-old woman with cancer develops fatigue and low mood during chemotherapy. She scores 16/27 on the PHQ-9 (moderate-severe depression). What is the appropriate management?

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Correct answer: E — Screen for reversible causes (anaemia, hypothyroidism, medication effects); if confirmed depression, offer psychological therapy (CBT) ± antidepressant medication; integrate with palliative care and cancer support services — cancer-related depression is treatable and should not be normalised

Depression affects 20-30% of cancer patients and significantly impacts quality of life, treatment adherence and survival. NICE recommends screening and stepped-care management: mild → guided self-help, physical activity; moderate → CBT/counselling ± SSRI (sertraline, citalopram — avoid paroxetine/fluoxetine with tamoxifen due to CYP2D6 interaction); severe → specialist psychiatric referral, combined therapy. Mirtazapine has additional benefits in cancer (appetite stimulation, anti-emetic, sleep improvement). Depression should be actively treated, not normalised as an expected response to cancer.

Reference: NICE CG91 Depression in chronic illness; ESMO 2024 Supportive Care; NICE NG Improving supportive and palliative care