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Desire for hastened death (DHD) is reported in the literature as being common
in patients with cancer pain. However, there is currently little evidence to
suggest that improvement in pain results in improvement in DHD. Our objectives
were to assess 1) the impact of improvements in cancer pain severity and pain's
interference with daily functioning and depression on DHD, and 2) the role of
factors such as social and spiritual well-being, educational level, and patient
age in moderating the impact of pain and depression on DHD. This observational
study included patient-rated and clinician-rated scales administered twice at
4-week intervals. We enrolled 131 newly-referred patients to the Pain and Palliative
Care Service at Memorial Sloan-Kettering Cancer Center or newly-admitted patients
to Calvary Hospital in New York. One hundred and sixteen patients completed
the baseline measures and 64 patients completed both baseline and follow-up
measures. The main outcome measures included the Brief Pain Inventory (BPI),
Beck Depression Inventory (BDI), and the Desire for Hastened Death Scale (DHD).
Sixty-six percent of patients had no DHD at baseline and 45% of patients had
BDI scores of 14 or greater ('mild' depression). Only 40% of patients with moderate/severe
depression were receiving antidepressants. BPI scores improved significantly
from baseline to follow-up (6.36 vs. 4.86, P < 0.01). DHD scores increased
significantly from baseline to follow-up (0.84 to 1.38, P=0.03). All other measures
including depression were stable. DHD scores were moderately correlated with
depression (r=0.43), low social support (r=0.38), poor spiritual well-being
(r=-0.38), religious well being (r=-0.25), pain interference (r=0.27), higher
educational level (F=4.50, P=0.02) and lower physical functioning (KPRS, r=-0.40),
but were unrelated to sex, age, race, or marital status. In multivariate regression
analyses, baseline DHD (beta=0.30, P=0.05) and change in depression (beta=0.36,
P=0.02) were predictive of follow-up DHD. Improvement in pain interference was
not predictive of follow-up DHD. The results suggest that improvement in depression
moderated the severity of desire for hastened death in a population of patients
with cancer pain. Depression was common in this population and was often untreated.
Improvements in functional impairment due to pain did not moderate the severity
of DHD in a setting of aggressive pain management. Strategies to preemptively
screen for depression in the routine assessment of patients with cancer pain
may be important to address DHD. O'mahony S, Goulet J, Kornblith A, Abbatiello
G, Clarke B, Kless-Siegel S, Breitbart W, Payne R. J Pain Symptom Manage. 2005
May;29(5):446-457.
PubMed Abstract:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15904747&query_hl=17
Credit: All abstracts retrieved from PubMed, developed by the National Center
for Biotechnology Information (NCBI) at the
National Library of Medicine (NLM).
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