Providing nursing support for oncology patients with depression (by guest blogger Nicole Muscari)

Depression – what do we know?

• Has a higher occurrence rate in oncology patients compared to the general population
• Evidence exists that depression effects a patient’s survival and overall quality of life
• Signs and symptoms may include:
  • Loss of interest or enjoyment in activities they once enjoyed
  • Low mood
  • Fatigue
  • Insomnia
  • Decreased energy
  • Changes in weight or appetite
  • Difficulty thinking or concentrating
  • Feelings of worthlessness or guilt
  • Thoughts of death or suicide

Many of the signs and symptoms of depression are the same symptoms that occur with cancer and cancer treatments. We assess toxicity of these symptoms during chemotherapy or other cancer treatment. Because of this, you may consider asking direct questions to a patient about how they are coping.

Questions to ask:

• Are you depressed?
• What type of support system do you have?
• Side effects of treatment can be stressful to deal with – how are you managing these at home?
• What coping strategies have you tried?
• What are you doing for self-care?
• Consider risk factors such as:
  • Family history of depression
  • Substance abuse
  • Other chronic illness
  • History of depression or suicide attempt

Nursing Interventions for Depression

• Patient education! Knowledge is power – might sound cliché, but patients really appreciate understanding their illness, their treatment and plan of care.
• Help your patient set realistic and attainable goals. Maybe your patient has several issues, for example -insomnia. Develop strategies with your patient (include provider as needed) for sleep management and plan a time to follow up (perhaps at their next visit) with them to follow up on their sleep goals.
• Relaxation therapy! Provide patients with tools they can use for guided imagery,

  progressive muscle relaxation,

  or mindfulness based stress reduction like yoga that your patient is interested that may help with relaxation. Educate your patient on these techniques and set a goal for incorporating relaxation therapy into their plan of care!

• Link patients with resources. Refer them to psychosocial support through social work and psycho-oncology. Patients may be more likely to utilize these resources if nursing refers them!
• Link patients to the community. You may suggest local support groups, James care for Life programming, or other community based programs.
• Medication recommendations. Antidepressants are often prescribed for patients by their providers – but are much more effective for patients who are also receiving counseling, behavioral therapy or social support.
• Use your nursing resources! Oncology Nursing Society has a PEP program (Putting Evidence into Practice) with evidence-based nursing interventions for depression.

References

Amen, K. (2010, December). Evidence-based interventions for depression in patients with cancer. American Nurse Today, 5(12). Retrieved from americannursetoday.com

Oncology Nursing Society website. (2016). ons.org

Background of Guest Blogger: Nicole Muscari is a Graduate Student at The Ohio State University studying Psychiatric Mental Health Advanced Practice Nursing and plans to graduate in May 2017. She has been a registered nurse for 15 years and has worked for The James Cancer Hospital for 13 years. She received her undergraduate BSN degree from The Ohio State University College of Nursing.