The author discusses the prevalence of psychiatric problems in cancer, and highlights five emotional problems common to all cancer patients: the emotionally charged nature of the word cancer, the patient's perceived lack of control, the uncertainty about outcome, the discordant treatment mode, and the debilitating nature of cancer treatments. The author then divides the problems faced by breast cancer patients into three categories needing clinical intervention: (I) the psychosocial, (2) the somatic, and (3) the psychiatric.
Diagnosis and treatment of the two psychiatric problems of depression and delirium is emphasized.
Cancer 539320-824, 1984.
HE PREVALENCE of psychiatric illness in cancer gen-T erally is not precisely known. The following will be a practical discussion of the psychiatric problems in breast cancer that patients may confront. Results of prevalence studies vary and depend to some extent on age, type of therapy, stage of treatment, and a multitude of other variables that often are not controlled in the investigations. The referral of cancer patients to a psychiatrist is probably lower than in other illnesses,' and, if one excludes the diagnosis of adjustment reaction to stress, cancer patients are basically a psychologically healthy population of people.* When psychiatric illness does occur, however, depression and delirium are the two most common dia g n o s e ~. ~. ~ If we consider just patients with breast cancer, the frequency of major psychiatric illness in this group is probably not greater than in any other chronic seriously ill group. In fact, one investigation of breast cancer patients did not find any major psychiatric illness in 150 patients studied at three different times during the course of illne~s.~ However, when hospitalized cancer patients are referred for psychiatric consultation, breast cancer patients appear to be represented at twice the expected rate.3.