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Use of primary breast carcinoma characteristics to predict lymph node metastases

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CANCER May 1, 1997 / Volume 79 / Number 9
In conclusion, it should be considered carefully
whether or not patients with cancer suffer from psychiatric disturbances such as delirium or depression.
Author Reply
e read with great interest the comments made by
Barista et al. on our original article. They suggest
that there may exist serious psychologic distress in a
certain type of cancer. We found that terminally ill
cancer patients often suffer from delirium,1 whereas
Barista et al. suggest that other factors (i.e., Mediterranean lymphoma) may have some effect on the nature
and prevalence of psychiatric disturbance.
The variety of psychologic responses of patients
with cancer ranges widely, and some, such as the two
patients discussed by Barista et al., develop severe distress. Some physicians may consider suicide in those
who face the distress of cancer as rational and as a
means to obtain a dignified death. However, Breitbart
reported that approximately 20% of suicidal cancer
patients had delirium or other organic brain syndromes at the time of the psychiatric evaluation.2 This
indication is very important among terminally ill cancer patients because delirium is one of the most common types of psychiatric disturbance in such populations, as our study reported.1
In addition to active suicide, euthanasia and physician-assisted suicide have received attention in the
oncology setting. When patients cannot make a clear
judgment regarding the desired course of action because of psychiatric dysfunction, there can be some
situations in which there is terrible suffering that does
not end until their death.3 When patients make suicidal statements or request the life-terminating acts,
oncologists should evaluate their level of competence.
/ 7b55$$1030
12-24-97 08:38:49
Minagawa H, Uchitomi Y, Yamawaki S, Ishitani K. Psychiatric morbidity in terminally ill cancer patients: a prospective
study. Cancer 1996;78:1131–7.
Breitbart W. Suicide in cancer patients. In: Holland JC, Rowland JH, editors. Handbook of psycho-oncology. New York:
Oxford University Press, 1989:291–9.
Pijnenborg L, van der Maas PJ, van Delden JJM, Looman
CWN. Life-terminating acts without explicit request of patients. Lancet 1993;341:1196–9
Hideaki Minagawa, M.D.
Department of Psychiatry
and Neurosciences
Hiroshima University
School of Medicine
Hiroshima City, Japan
Yosuke Uchitomi, M.D., Ph.D.
Psycho-oncology Division
National Cancer Center
Research Institute East
Kashiwa City, Japan
Shigeto Yamawaki, M.D., Ph.D.
Department of Psychiatry
and Neurosciences
Hiroshima University
School of Medicine
Hiroshima City, Japan
Kunihiko Ishitani, M.D., Ph.D.
Higashi Sapporo Hospital
Sapporo City, Japan
W: Cancer
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carcinoma, characteristics, node, primary, metastasis, predict, lymph, use, breast
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