Treatment Response to Psychiatric Intervention and Predictors of Response Among Cancer Patients with Adjustment Disorders

Context. Although adjustment disorders (ADs) are common among patients with cancer and such patients are frequently referred to consultation-liaison psychiatrists, little is known about the clinical courses of these patients. Objectives. The present study investigated treatment response to psychiatric intervention and predictors of response in a relatively large sampling of cancer patients with ADs. Methods. We created a database of all referral cases with ADs that included data on the patients' demographic and medical factors and physician-rated Clinical Global Impression (CGI) scale to assess treatment response and clinical course. A CGI-Improvement scale score of better than "much improved" was regarded as indicating a response to treatment; the number of patients who responded to treatment during a four-week follow-up period was assessed. Also, predictors of treatment response were explored by examining demographic and medical factors using a multivariate analysis. Results. Among the 238 eligible patients, 136 (57.1%) responded to psychiatric treatment; most of these responders improved to a subthreshold level of illness. On the other hand, 56 patients (23.5%) did not respond to psychiatric treatment, seven patients (2.9%) developed major depressive disorders, and 39 patients (16.4%) discontinued treatment before achieving a response. Among the predictive factors that were explored, suffering from pain significantly predicted a good treatment response, whereas a worse performance status predicted a poor treatment response. Conclusion. Cancer patients with ADs can respond to psychiatric treatment, but a few cases develop major depressive disorders. Several predictors of treatment response were identified. J Pain Symptom Manage 2011; 41: 684-691. (c) 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.