[Depression and cancer: from the viewpoint of the cancer oncologist]

For the oncologist, depression is a commonly occurring phenomenon which is encountered at all stages of the patient's diagnosis, treatment and clinical course. The diagnosis of cancer is in itself a major source of stress. Initial rejection of the diagnosis is frequently followed by a period of total annihilation in which the patient seems to withdraw, and it is not always obvious how to get him or her to accept the diagnosis and the therapeutic options simultaneously. These two stages are often linked, and the patient usually has to tolerate news of his or her diagnosis, information regarding treatments and, in certain cases, the hazards of treatment all at the same time. The therapy bears witness to the disease: cancer; this concept, which in itself is impossible to bear, will immediately be compounded by the hazards of the therapy. This is especially obvious when major surgery is mentioned. This initial stressful phase is a major source of disequilibrium, and is not always appropriately analysed by the clinician, who is more sensitive to the quality of the explanation than to its effect on the patient. The description of the treatments often represents an intense emotional shock. Chemotherapy represents generalised sickness and physical change (alopecia). Surgery represents aesthetic and functional mutilation. The period of active treatment is frequently better tolerated, and anxiety or depressive syndromes are rarely encountered during the initial phase. But as soon as he or she has comprehended the severity of the sequelae of therapy, the patient presents with a veritable fulmination which now embraces the severity of the disease and the definitive nature of its sequelae.(ABSTRACT TRUNCATED AT 250 WORDS)