Marco Colleoni and colleagues at the European Institute of Oncology (Milan, Italy) found that patients who suffer with depression are less likely to follow through with disease treatment, especially with breast cancer (Lancet 2000, 356, 1326–1327). James Baker, a psychologist at the American Cancer Society, agrees. “Studies of the relationship between anxiety and noncompliance versus depression and noncompliance show those patients with depression are three times more likely not to comply with the doctor’s orders for treatment.”

Jeremy Kisch, a clinical psychologist at the National Mental Health Association, says one reason for the non-aggressive approach by depressed cancer patients is the common feeling of fatalism—that treatment or therapy is pointless. Colleoni found that about 30% of breast cancer patients suffer with depression.

Recognizing the warning signs of depression can be complicated. Common symptoms include unhappiness, frequent crying, panic attacks, and loss of appetite. Unfortunately, these symptoms are often interpreted as the “normal reaction” of people diagnosed with cancer, even among oncologists. Some patients recognize their depression but are too embarrassed to seek help. Colleoni hypothesized that psychologically supporting depressed patients may increase their willingness to accept chemotherapy.

But if the warning signs for depression aren’t particularly definitive, what does this mean for physicians and staff treating women with breast cancer? “It means that whoever the doctors are, including the oncologists, [they] need to be more aggressive in identifying women who may be depressed and facilitating their getting into treatment,” said Kisch. To assist doctors and other health care professionals, a set of standards for patients with depression has been proposed by various cancer center networks. Recognizing this mental condition in its initial stages is the key to success. “In places where the doctors, nurses, and oncologists are trained to deal with depression, it really makes a difference,” said Baker.

Fighting breast cancer is already an uphill battle for millions of women. However, breast cancer coupled with depression affects the motivation to seek treatment. With the proper recognition, support, and treatment of depression, the motivation to seek treatment increases, and therefore so does the chance of beating the cancer.