Terminal Care of Cancer Patients : With special reference to their depressive state(Care of the Dying)

Abstract

In the Western world hospices and nursing teams are already available for the care of dying patients and in fact are functioning effectively. Such facilities and organizations are also gradually coming into being in Japan.Successful management of terminal patients requires a humane holistic bio-psycho-socio-ethical approach from a standpoint of psychosomatic medicine.Kubler-Ross classified the psychological process of moribund persons into 5 stages, including one of depression. According to her, there re two types of depression, i. e. reactive depression and preparative depression. The former type of depression is a problem that must be solved early and one of the important factors productive of depressive reaction is the pain of cencer.Seventy to 90% of terminal stage cancer patients are suffering from pain and it is well known that chronic pains give rise to a depressive state.We assessed 15 terminal cancer patients with pain for depression using the Toho University Depression Scale (Self Rating Questionnaire for Depression, SRQ-D). According to the results, the mean depression score was 11.1±6.9; 4 of the patients had a high score on the scale, 3 others had a moderately high score and 46.7% were found to exhibit a more or less distinct tendency to depression.On the other hand, antidepressant drugs are known to have an action to elevate the pain threshold. When 5 cases with cancer pain and depression were treated with clomipramine given by intravenous drip infusion, pain relief of a dosage reduction of analgesics with disappearance of depression was achieved in 3 of the 4 cases. In the remaining one case, the use of clomipramine was attended by lassitude and nausea, hence the medication was discontinued.In caring for terminal patients, relieving them of somatic distress is the minimum necessity. The fact that antidepressant medication proved to be effective not only in the relief of cancer pain (which perhaps in the greatest of all physical pains) but also in lifting or combatting depression encourages us to use positively such a drug therapy in the management of terminal cancer patients.