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Table of Contents Introduction
Overview
Diagnosis
Treatment
Evaluation and Treatment of Suicidal Patients with Cancer
Assisted Dying, Euthanasia, and Decisions Regarding End of Life
Considerations for Depression in Children
Suicide and Children
Get More Information From NCI
Changes to This Summary (12/19/2008)
Questions or Comments About This Summary
About PDQ
Introduction
This patient summary on depression is adapted from a summary
written for health professionals by cancer experts. This and other credible
information about cancer treatment, screening, prevention, supportive care, and
ongoing clinical trials, is available online at NCI's Web site.
This brief summary describes the causes and treatment of depression,
and risk factors and prevention of suicide in adults and children who have
cancer.
Back to Top Overview
Depression is a disabling illness that affects about 15% to 25% of cancer patients. It affects men and women with cancer equally. People who face a diagnosis of cancer will experience different levels of stress and emotional upset. Important issues in the life of any person with cancer may include the following:
- Fear of death.
- Interruption of life plans.
- Changes in body image and self-esteem.
- Changes in social role and lifestyle.
- Money and legal concerns.
Everyone who is diagnosed with cancer will react to these issues in different ways and may not experience serious depression or anxiety.
Patients who are receiving palliative care for cancer may have frequent feelings of depression and anxiety, leading to a much lower quality of life. Patients in palliative care who suffer from depression report being more troubled about their physical symptoms, relationships, and beliefs about life. Depressed terminally ill patients have reported feelings of "being a burden" even when the actual amount of dependence on others is small.
Just as patients need to be evaluated for depression throughout their treatment, so do family caregivers. Caregivers have been found to experience a good deal more anxiety and depression than people who are not caring for patients with cancer. Children are also affected when a parent with cancer develops depression. A study of women with breast cancer showed that children of depressed patients were the most likely to have emotional and behavioral problems themselves.
There are many misconceptions about cancer and how people cope with it, such as
the following:
- All people with cancer are depressed.
- Depression in a person
with cancer is normal.
- Treatment does not help the depression.
- Everyone
with cancer faces suffering and a painful death.
Sadness and grief are normal
reactions to the crises faced during cancer, and will be experienced at times
by all people. Because sadness is common, it is important to distinguish between
normal levels of sadness and depression. An important part of cancer care is
the recognition of depression that needs to be treated. Some people may have
more trouble adjusting to the diagnosis of cancer than others may. Major
depression is not simply sadness or a blue mood. Major depression affects
about 25% of patients and has common symptoms that can be diagnosed and
treated.
Symptoms of depression that are noticed when a patient is diagnosed with cancer may be a sign that the patient had a depression problem before the diagnosis of cancer.
All people will experience reactions of sadness and grief periodically
throughout diagnosis, treatment, and survival of cancer. When people find out
they have cancer, they often have feelings of disbelief, denial, or despair.
They may also experience difficulty sleeping, loss of appetite, anxiety, and a
preoccupation with worries about the future. These symptoms and fears usually
lessen as a person adjusts to the diagnosis. Signs that a person has adjusted
to the diagnosis include an ability to maintain active involvement in daily
life activities, and an ability to continue functioning as spouse, parent,
employee, or other roles by incorporating treatment into his or her schedule.
If the family of a patient diagnosed with cancer is able to express feelings openly and solve problems effectively, both the patient and family members have less depression. Good communication within the family reduces anxiety. A person who cannot adjust to the diagnosis after a long period of time, and
who loses interest in usual activities, may be depressed. Mild symptoms of
depression can be distressing and may be helped with counseling. Even patients
without obvious symptoms of depression may benefit from counseling; however,
when symptoms are intense and long-lasting, or when they keep coming back, more
intensive treatment is important.
Back to Top Diagnosis
The symptoms of major depression include the following:
- Having a depressed mood for most of
the day and on most days.
- Loss of pleasure and interest in most activities.
- Changes in eating and sleeping habits.
- Nervousness or sluggishness.
- Tiredness.
- Feelings of worthlessness or inappropriate guilt.
- Poor concentration.
- Constant thoughts of death or suicide.
To make a diagnosis of depression,
these symptoms should be present on most days for at least 2 weeks. The diagnosis of
depression can be difficult to make in people with cancer due to the difficulty
of separating the symptoms of depression from the side effects of medications or the symptoms of cancer. This is especially true in patients undergoing
active cancer treatment or those with advanced disease. Symptoms of guilt,
worthlessness, hopelessness, thoughts of suicide, and loss of pleasure are the
most useful in diagnosing depression in people who have cancer.
Some people with cancer may have a higher risk for developing depression. The
cause of depression is not known, but the risk factors for developing depression are known. Risk factors may be cancer-related and noncancer-related.
- Cancer-Related Risk Factors:
- Noncancer-Related Risk Factors:
- History of depression.
- Lack of family support.
- Other life events that cause stress.
- Family history of depression or suicide.
- Previous suicide attempts.
- History of alcoholism or drug abuse.
- Having many illnesses at the same time that produce symptoms of depression (such as stroke or heart attack).
The evaluation of depression in people with cancer should include a careful
evaluation of the person's thoughts about the illness; medical history;
personal or family history of depression or suicide; current mental status;
physical status; side effects of treatment and the disease; other stresses in
the person's life; and support available to the patient. Thinking of suicide,
when it occurs, is frightening for the individual, for the health care worker,
and for the family. Suicidal statements may range from an offhand comment
resulting from frustration or disgust with a treatment course, such as "If I have to
have one more bone marrow aspiration this year, I'll jump out the window," to a
statement indicating deep despair and an emergency situation, such as, "I can't stand
what this disease is doing to all of us, and I am going to kill myself."
Exploring the seriousness of these thoughts is important. If the thoughts of
suicide seem to be serious, then the patient should be referred to a psychiatrist or psychologist, and the safety of the patient should be secured.
The most common type of depression in people with cancer is called reactive
depression. This shows up as feeling moody and being unable to perform usual
activities. The symptoms last longer and are more pronounced than a normal and
expected reaction but do not meet the criteria for major depression. When
these symptoms greatly interfere with a person's daily activities, such as
work, school, shopping, or caring for a household, they should be treated in
the same way that major depression is treated (such as crisis intervention, counseling, and medication, especially with drugs that can quickly relieve distressing symptoms). Basing the diagnosis on just these symptoms can be a
problem in a person with advanced cancer since the illness may be causing
decreased functioning. It is important to identify the difference between fatigue and depression since they can be assessed and treated separately. In more advanced illness, focusing on despair, guilty
thoughts, and a total lack of enjoyment of life is helpful in diagnosing
depression.
(Refer to the PDQ summary on Normal Adjustment and the Adjustment Disorders for further information.)
Medical factors may also cause symptoms of depression in patients with cancer. Medication
usually helps this type of depression more effectively than counseling,
especially if the medical factors cannot be changed (for example, dosages of
the medications that are causing the depression cannot be changed or stopped).
Some medical causes of depression in patients with cancer include uncontrolled pain; abnormal levels of calcium, sodium, or potassium in the blood; anemia; vitamin B 12 or folate deficiency; fever; and abnormal levels of thyroid hormone or steroids in the blood.
Back to Top Treatment
Treatment with Drugs
Major depression may be treated with a combination of counseling and medications (drugs), such as antidepressants. A primary care doctor may prescribe
medications for depression and refer the patient to a psychiatrist or psychologist for the following reasons:
- A physician or oncologist is not
comfortable treating the depression (for example, the patient has suicidal thoughts).
- The symptoms of depression do not improve after 2 to 4 weeks of
treatment.
- The symptoms are getting worse.
- The side effects of the medication
keep the patient from taking the dosage needed to control the depression.
- The symptoms are interfering with the patient's ability to continue
medical treatment.
Antidepressants are usually effective
in the treatment of depression and its symptoms. Unfortunately,
antidepressants are not prescribed often for patients with cancer. About 25% of all patients are depressed, but only about 16% receive medication for the
depression. The choice of antidepressant depends on the patient's symptoms,
potential side effects of the antidepressant, and the person's individual
medical problems and previous response to antidepressant drugs.
The Food and Drug Administration (FDA) has issued a warning that patients who are taking antidepressants, such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), bupropion (Wellbutrin), venlafaxine (Effexor), nefazodone (Serzone), and mirtazapine (Remeron), should be closely monitored for signs of worsening depression and suicidal thoughts. A Patient Medication Guide (MedGuide) should also be given to patients receiving antidepressants to warn them of the risk and suggest precautions that can be taken.
The FDA has also directed manufacturers of all antidepressant drugs to change the labeling for their products to include a boxed warning and more detailed warning statements about increased risk of suicidal thinking and behavior in children and adolescents being treated with antidepressants. Some studies show that the benefits of proper antidepressant use in children and adolescents, including careful monitoring for suicidal behavior, may outweigh the risks. However, for children younger than 12 years with major depression, only fluoxetine (Prozac) showed benefit compared to a placebo.
Patients with cancer may be treated with a number of drugs throughout their care. Some drugs do not mix safely with certain other drugs, foods, herbals, and nutritional supplements. Certain combinations may reduce or change how drugs work or cause life-threatening side effects. It is important that the patient's healthcare providers be told about all the drugs, herbals, and nutritional supplements the patient is taking, including drugs taken in patches on the skin. This can help prevent unwanted reactions.
St. John's wort (Hypericum perforatum) has been used as an over-the-counter supplement for mood enhancement. In the United States, dietary supplements are
regulated as foods, not as drugs. The FDA does not require that supplements be approved before being put on the market. Because
there are no standards for product manufacturing consistency, dose, or purity,
the safety of St. John's wort is not known. The FDA has issued a warning that
a significant drug interaction occurs between St. John's wort and indinavir (a drug used to treat HIV infection). When St. John's wort and indinavir are
taken together, indinavir is less effective. Patients with symptoms of
depression should be evaluated by a health professional and not self-treat with
St. John's wort. St. John's wort is not recommended for major depression in
patients who have cancer.
Most antidepressants take 3 to 6 weeks to begin working. The side effects must
be considered when deciding which antidepressant to use. For example, a
medication that causes sleepiness may be helpful in an anxious patient who is
having problems sleeping, since the drug is both calming and sedating.
Patients who cannot swallow pills may be able to take the medication as a
liquid or as an injection. If the antidepressant helps the symptoms, treatment
should continue for at least 6 months. Electroconvulsive therapy (ECT) is a
useful and safe therapy when other treatments have been unsuccessful in
relieving major depression.
Treatment with Psychotherapy
Several psychiatric therapies have been found to be helpful in the
treatment of depression related to cancer. Most therapy programs for depression are given in 4 to 30 hours and are offered in both individual and group settings. They may include sessions about cancer education or relaxation skills. These therapies are often used in
combination and include crisis intervention, psychotherapy, and
thought/behavior techniques. Patients explore methods of lowering distress, improving coping and
problem-solving skills; enlisting support; reshaping negative and
self-defeating thoughts; and developing a close personal bond with an
understanding health care provider. Talking with a clergy member may also be
helpful for some people.
Specific goals of these therapies include the following:
- Assist people diagnosed with cancer and their families by answering
questions about the illness and its treatment, explaining information,
correcting misunderstandings, giving reassurance about the situation,
and exploring with the patient how the diagnosis relates to previous
experiences with cancer.
- Assist with problem solving, improve the patient's coping skills, and
help the patient and family to develop additional coping skills.
Explore other areas of stress, such as family role and lifestyle
changes, and encourage family members to support and share concern
with each other.
- Ensure that the patient and family understand that support will continue when the focus of treatment changes from trying to cure the cancer to
relieving symptoms. The health care team will treat symptoms to help the patient control pain and remain comfortable, and will help the patient and his or her family members maintain dignity.
Cancer support groups may also be helpful in treating depression in
patients with cancer, especially adolescents. Support groups have been shown to improve
mood, encourage the development of coping skills, improve quality of life, and
improve immune response. Support groups can be found through the wellness
community, the American Cancer Society, and many community resources, including
the social work departments in medical centers and hospitals.
Recent studies of psychotherapy in patients with cancer, including training in problem solving, have shown that it helps decrease feelings of depression.
Back to Top Evaluation and Treatment of Suicidal Patients with Cancer
The incidence of suicide in cancer patients may be as much as 10 times higher
than the rate of suicide in the general population. One study has shown that the risk of suicide in patients with cancer is highest in the first months after diagnosis, and that this risk decreases significantly over decades. Passive suicidal thoughts
are fairly common in patients with cancer. The relationships between suicidal
tendency and the desire for hastened death, requests for physician -assisted
suicide, and/or euthanasia are complicated and poorly understood. Men with
cancer are at an increased risk of suicide compared with the general
population, with more than twice the risk. Overdosing with painkillers and sedatives is the most common method of suicide by patients with cancer, with most
cancer suicides occurring at home. The occurrence of suicide is higher in
patients with oral, pharyngeal, and lung cancers, and in HIV-positive patients
with Kaposi sarcoma. The actual incidence of suicide in cancer patients is
probably underestimated, since there may be reluctance to report these deaths
as suicides.
General risk factors for suicide in a person with cancer include the following:
Cancer-specific risk factors for suicide include the following:
Patients who are suicidal require careful evaluation. The risk of suicide
increases if the patient reports thoughts of suicide and has a plan to carry it
out. Risk continues to increase if the plan is "lethal," that is, the plan is
likely to cause death. A lethal suicide plan is more likely to be carried out
if the way chosen to cause death is available to the person, the attempt cannot
be stopped once it is started, and help is unavailable. When a person with
cancer reports thoughts of death, it is important to determine whether the
underlying cause is depression or a desire to control unbearable symptoms.
Prompt identification and treatment of major depression is important in
decreasing the risk for suicide. Risk factors, especially hopelessness (which
is a better predictor for suicide than depression) should be carefully
determined. The assessment of hopelessness is not easy in the person who has advanced cancer with no hope of a cure. It is important to determine the basic
reasons for hopelessness, which may be related to cancer symptoms, fears of
painful death, or feelings of abandonment.
Talking about suicide will not cause the patient to attempt suicide; it
actually shows that this is a concern and permits the patient to describe his
or her feelings and fears, providing a sense of control. A crisis
intervention -oriented treatment approach should be used which involves the
patient's support system. Contributing symptoms, such as pain, should be aggressively controlled and depression, psychosis, anxiety, and underlying
causes of delirium should be treated. These problems are usually treated in a
medical hospital or at home. Although not usually necessary, a suicidal
patient with cancer may need to be hospitalized in a psychiatric unit.
The goal of treatment of suicidal patients is to attempt to prevent suicide
that is caused by desperation due to poorly controlled symptoms. Patients
close to the end of life may not be able to stay awake without a great amount
of emotional or physical pain. This often leads to thoughts of suicide or
requests for aid in dying. Such patients may need sedation to ease their distress.
Other treatment considerations include using medications that work quickly to
alleviate distress (such as antianxiety medication or stimulants) while
waiting for the antidepressant medication to work; limiting the quantities of
medications that are lethal in overdose; having frequent contact with a health
care professional who can closely observe the patient; avoiding long periods of
time when the patient is alone; making sure the patient has available support;
and determining the patient's mental and emotional response at each crisis
point during the cancer experience.
Pain and symptom treatment should not be sacrificed simply to avoid the
possibility that a patient will attempt suicide. Patients often have a method
to commit suicide available to them. Incomplete pain and symptom treatment
might actually worsen a patient's suicide risk.
Frequent contact with the health professional can help limit the amount of
lethal drugs available to the patient and family. Infusion devices that limit
patient access to medications can also be used at home or in the hospital.
These are programmable, portable pumps with coded access and a locked cartridge
containing the medication. These pumps are very useful in controlling pain and
other symptoms. Some pumps can give multiple drug infusions, and some can be
programmed over the phone. The devices are available through home care
agencies, but are very expensive. Some of the expense may be covered by
insurance.
Effects of suicide on family and health care providers
Suicide can make the loss of a loved one especially difficult for survivors.
Survivors often have reactions that include feelings of abandonment, rejection,
anger, relief, guilt, responsibility, denial, identification, and shame. These
reactions are affected by the type and intensity of relationship; the nature of
the suicide; the age and physical condition of the deceased; the survivor's
support network and coping skills; and cultural and religious beliefs.
Survivors should have help during this period of grieving. Mutual support
groups can lessen isolation, provide opportunities to discuss feelings, and
help survivors find ways to cope.
The reactions of health care providers to the suicide are similar to those seen
in family members, although caregivers often do not feel they have the right to
express their feelings.
Back to Top Assisted Dying, Euthanasia, and Decisions Regarding End of Life
Respecting and promoting patient control has been one of the driving forces
behind the hospice movement and right-to-die issues that range from honoring living wills to promoting euthanasia (mercy killing). These issues can create
a conflict between a patient's desire for control and a physician's duty to
promote health. These are issues of law, ethics, medicine, and philosophy.
Some physicians may favor strong pain control and approve of the right of
patients to refuse life support, but do not favor euthanasia or assisted
suicide. Often patients who ask for physician-assisted suicide can be treated
by increasing the patient's comfort and relieving symptoms, thereby reducing the
patient's need for drastic measures. Patients with the desire to die should be
carefully evaluated and treated for depression.
(See the PDQ summary on Last Days of Life for more information.)
Back to Top Considerations for Depression in Children
Most children cope with the emotions related to cancer and not only adjust
well, but show positive emotional growth and development. A small number
of children, however, develop psychological problems including depression, anxiety,
sleeping problems, relationship problems, and are uncooperative about
treatment. A mental health specialist should treat these children.
Children with severe late effects of cancer have more symptoms of depression.
Anxiety usually occurs in younger patients, while depression is more common in
older children. Most cancer survivors are generally able to adapt and adjust
successfully to cancer and its treatment; however, a small number of cancer
survivors have difficulty adjusting.
Diagnosis of Childhood Depression
The term depression refers to a symptom or a set of symptoms or conditions that occur together and suggest the presence of depression, or an illness. A diagnosis of depression as an illness depends on how severe the symptoms are and how long they last. For example, a child
may be sad in response to trauma, and the sadness usually lasts a short time.
Depression, however, is marked by a response that lasts a long time, and is
associated with sleeplessness, irritability, changes in eating habits, and
problems at school and with friends. Depression should be considered whenever
any behavior problem continues. Depression does not refer to temporary moments
of sadness, but rather to a disorder that affects development and interferes
with the child's progress.
Some signs of depression in the school-aged child include the following:
- Not eating.
- Inactivity.
- Looking sad.
- Aggressive behavior.
- Crying.
- Hyperactivity.
- Physical
complaints.
- Fear of death.
- Frustration.
- Feelings of sadness or hopelessness.
- Self-criticism.
- Frequent daydreaming.
- Low self-esteem.
- Refusing to go to
school.
- Learning problems.
- Slow movements.
- Showing anger towards parents and
teachers.
- Loss of interest in activities that were previously enjoyed.
Some of these signs can occur in response to normal developmental stages;
therefore, it is important to determine whether they are related to depression
or a developmental stage.
Determining a diagnosis of depression includes evaluating the child's family
situation, as well as his or her level of emotional maturity and ability to cope with illness and treatment; the child's age and state of development; and
the child's self esteem and prior experience with illness.
A comprehensive assessment for childhood depression is necessary for effective
diagnosis and treatment. Evaluation of the child and family situation focuses
on the child's health history; observations of the behavior of the child by
parents, teachers, or healthcare workers; interviews with the child; and use
of psychological tests.
Childhood depression and adult depression are different illnesses due to the
developmental issues involved in childhood. The following criteria may also be
used for diagnosing depression in children:
- A sad mood (and a sad facial
expression in children younger than 6) with at least 4 of the following signs
or symptoms present every day for a period of at least 2 weeks:
- Appetite changes.
- Either not sleeping or sleeping too much.
- Being either too active or not active
enough.
- Loss of interest or pleasure in usual activities.
- Signs of not caring
about anything (in children younger than 6).
- Tiredness or loss of energy.
- Feelings of worthlessness.
- Self-criticism or inappropriate guilt.
- Inability to
think or concentrate well.
- Constant thoughts of death or suicide.
Treatment of Childhood Depression
Individual and group counseling are usually used as the first treatment for a
child with depression, and are directed at helping the child to master his or
her difficulties and develop in the best way possible. Play therapy may be
used as a way to explore the younger child's view of him- or herself, the
disease, and treatment. From the beginning of treatment, a child needs help to understand,
at his or her developmental level, the diagnosis of cancer and the treatment
involved. A doctor may prescribe medications, such as antidepressants, for
children. Some of the same antidepressants prescribed for adults may also be
prescribed for children. (Refer to the Treatment section for information about FDA warnings on antidepressant use in children and adolescents.)
Back to Top Suicide and Children
Suicide is as rare among adolescents who have no other mental disorders as it
is among adults. The adolescent often believes that his or her disease is
outside the realm of control, and is in the hands of God or some other force.
Refusing treatment is not a way of attempting suicide, but comes from his or
her belief that fate, luck, or God determines life and death.
In the general population, about 2,000 adolescents in the United States die by
suicide each year. Suicide continually ranks as the second or third leading
cause of death of persons between the ages of 15 and 34 years old. Children
are less prone to suicide before puberty due to immature reasoning capabilities
that make planning and carrying out suicide difficult. The suicide rate in
young people has more than doubled during the period from 1956 to 1993.
This increasing suicide rate has been blamed on the increase of adolescent alcohol abuse. Chronic and acute illnesses were not major causes of suicide in
the young. The suicide rate for male adolescents is four times as high as the
rate for females. The suicide rate for white adolescents is about twice as
great as the rate for African-Americans and Hispanics. Little is known about
the occurrence of thoughts of suicide and attempts in children with cancer.
The risk factors for the general population of children include:
- Biologic factors: Family history of mental problems such as depression, schizophrenia, alcoholism, drug dependence, and conduct disorders. Genetic predisposition to low levels of serotonin is associated with
depression.
- Predisposing life events: An early family history of abuse by a parent;
negative life event such as loss of a parent; childhood grief; and
disturbed, hostile relationships in the family. Many other social
problems and negative life events do not seem to cause suicidal
behavior.
- Social factors: The very nature of adolescence itself with its desire
to experiment with drugs and alcohol. Conflict or confusion about
sexual orientation can be a factor in adolescent suicide. Also,
characteristics such as perfectionism, impulsiveness, inhibition,
and isolation all can lead to thoughts of suicide.
- Mental problems: Ninety five percent of young people who commit suicide
have a mental disorder. These are usually major depression,
schizophrenia, alcoholism, drug dependence, and conduct disorder.
However, most children with mental problems do not commit suicide.
- Contagion: An expression that describes the phenomenon of young people
identifying with others who have committed suicide. Some young people
who are vulnerable may copy suicidal behavior. Friends of a
patient with cancer who has committed suicide should be offered support and counseling.
- Deadly weapons available: A gun in the house can allow suicide to
occur.
- Motivating events: The diagnosis of cancer can cause a person at risk
to attempt suicide. Usually a mental disorder, other life stresses, an
upsetting event such as a failure in school, or life-threatening
disease such as cancer is already present.
Some adolescent cancer survivors may be overwhelmed by feelings of
hopelessness. This may lead to thoughts of suicide. Suicide is treated by the
careful evaluation of the child with cancer and his or her family. The
multiple factors that can make a child's life unbearable need to be examined.
Suicide prevention must include individual evaluation; referral to the correct
health professionals; treatment with medications; and both individual
counseling and family therapy.
Back to Top Get More Information From NCI
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Back to Top Changes to This Summary (12/19/2008)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
Back to Top Questions or Comments About This Summary
If you have questions or comments about this summary, please send them to Cancer.gov through the Web site’s Contact Form. We can respond only to email messages written in English.
Back to Top About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one method of treating symptoms is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. Some patients have symptoms caused by cancer treatment or by the cancer itself. During supportive care clinical trials, information is collected about how well new ways to treat symptoms of cancer work. The trials also study side effects of treatment and problems that come up during or after treatment. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients who have symptoms related to cancer treatment may want to think about taking part in a clinical trial.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
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