Relevant Statistics — Mental Health and End-Of-Life Care: Talking Points by Barry Rosenfeld, Ph.D.

Pain and Symptom Management

  • More than 60% of patients with cancer and AIDS experience persistent pain 1,2

  • 42% of patients with cancer are under-medicated for their pain 1

  • 86% of patients with AIDS are under-medicated for their pain 2

  • 50% of doctors fear that their patients will become addicted to pain medications 3

  • less than 1 % of cancer patients actually become dependent on pain medications 4

  • 12 % of doctors receive "good" training in pain management/palliative care in medical school 5

Mental Health Care

  • 15-20% of terminally ill patients are diagnosed with a "major depression" 6,7

  • 49% of severely depressed cancer patients are considered (by their doctor) to have NO depression 8

  • 70-80% of terminally ill patients with depression respond to treatment (when provided) 9

  • roughly 50% of suicides in terminally ill patients are attributable to untreated depression 9

  • 25% of elderly depressed patients changed their minds about end-of-life interventions after treatment 11

References

1 Cleeland, C. S., Gonin, R., Hatfield, A. K., et al. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine, 330, 592-596.

2 Breitbart, W., Rosenfeld, B., McDonald, M., et al. (1996). Undertreatment of pain in ambulatory AIDS patients. Pain, 65, 243-249.

3 Breitbart, W., Kaim, M., and Rosenfeld, B. (1999). Clinicians? perceptions of barriers to pain management in AIDS. Journal of Pain and Symptom Management, 18, 203-212.

4 Passik, S. D., Kirsch, K. L., McDonald, M. V., et al. (2000). A pilot survey of aberrant drug-taking attitudes and behavior in samples of cancer and AIDS patients. Journal of Pain and Symptom Management, 19, 274-286.

5 Breitbart, W., Rosenfeld, B., and Passik, S. (1998). The Network Project: A multidisciplinary cancer education and training program in pain management, rehabilitation and psychosocial issues. Journal of Pain and Symptom Management, 15(1), 18-26.

6 Rosenfeld, B. (1998). Psychological sequelae of HIV disease and HIV-associated neoplasms. In J. Holland (Ed.) Handbook of Psycho-Oncology, 2nd Ed. New York: Oxford, 861-897.

7 Chochinov, H. M., Wilson, K. G., Enns, M., and Lander, S. (1994). Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judgments. American Journal of Psychiatry, 151, 537-540.

8 Passik, S. D., Dugan, W., McDonald, M. V., Rosenfeld, B., Theobald, D., and Edgerton, S. (1998). Oncologist?s recognition of depression in their patients with cancer. Journal of Clinical Oncology, 16, 1594-1600.

9 Foley, K. M. (1995). Pain, physician-assisted suicide, and euthanasia. Pain Forum, 4, 163-178.

10 Lee, M. A., Smith, D. M., Fenn, D. S., & Ganzini, L. (1998) Do patients' treatment decisions match advance statements of their preferences? Journal of Clinical Ethics, 9, 258-262.