Depression in Pancreatic Cancer: Sense of Impending Doom

nal cancers were statistically significant [3] . These findings are consistent with the data published so far. After the initial description in 1931, several studies have reported on the association between pancreatic cancer and the triad of anxiety, depression and ‘sense of impending doom’ [1, 2, 4, 5] . Remarkably high incidence rates were affirmed by a study in 1993 which showed depressive symptoms in 71% of the explored pancreatic cancer patients and ‘anxiety-related symptoms’ in 48% of the patients [6] . In a comprehensive review, Massie [7] referred to the prevalence of depression in pancreatic cancer between 33 and 50%. Different from the study by Lin et al. [3] , some trials performed prior to confirmation of cancer diagnosis observe psychological symptoms preceding somatic disorders [8, 9] . Therefore, a discussion about ‘mental symptoms as an aid in early diagnosis of pancreatic cancer’ was started [10–12] . This refers to the initial question for the scientific background concerning the bidirectional relationship between depression and pancreatic cancer. Lin et al. [3] documented by the presented analysis a linkage to TMN stages and intended treatments (chemotherapy or surgery) representing a patient’s assumed life expectancy and hope for recovery. This burden of emotional distress exceeding the patient’s capability of coping with tumor disease frequently results in development of major depression. In contrast, reporting high incidence rates for Pancreatic cancer is still one of the malignancies with the worst prognosis and associated with a high prevalence of depression. This relationship was already described about 70 years ago, but is still poorly understood [1, 2] . Dealing with this subject, one pivotal question remains: is this depression a feature of pancreatic cancer per se or is it rather a response to the experience of gradual loss of strength and body weight in patients with a life-threatening diagnosis? In this issue of Digestion , Lin et al. [3] report on the incidence of depression and quality of life in patients suffering from pancreatic cancer prior to surgery or chemotherapy comparing their cohort with patients with gastrointestinal cancer of other origin. All 262 recruited patients met the inclusion criteria which postulated them to be inpatients with an assured cancer diagnosis (pancreatic, liver, esophageal, gastric or colorectal cancer) and without any history of psychological or psychiatric diseases. Clinical features like age, gender, TNM stages and treatment strategy were well balanced. The incidence of depression was significantly higher in patients with pancreatic carcinoma than in those with other cancers of the digestive system. 78% of the pancreatic cancer patients suffered from depression and 60% of liver cancer patients, but only 36% of gastric cancer, 24% of esophageal cancer and 19% of colon cancer patients. The differences between pancreatic carcinoma and the other gastrointestiPublished online: February 9, 2010