Abstract
Dear Editor:
In his editorial, A.D. Macleod accurately describes the importance of the practice of psychiatry in palliative medicine. 1 Yet, he concludes that psychiatry and palliative medicine are too disparate to regularly incorporate psychiatrists into end-of-life care. While psychiatry and palliative medicine will always remain distinct disciplines, we believe that the care of patients with both medical and mental illness can be combined across clinical and research practice.
Collaboration between psychiatry and palliative medicine often occurs within the realm of symptom management. An example of this integration is the field of psycho-oncology, which has emerged as a subspecialty among psychiatrists and other mental health clinicians. Psychosocial care is now considered a key component of modern comprehensive cancer care, 2 and there is evidence to suggest that providing psychosocial care to oncology patients improves their mental health, 3 reduces symptom burden, 2 and increases quality of life. 4 Within psycho-oncology, palliative medicine clinicians and psychiatrists can focus on symptom management during curative intent treatment as well as end-of-life care.
What remains apparent, however, is the need for further evidence-based treatments for psychiatric disorders in patients with symptomatic, life-threatening medical illness like cancer. To help address this knowledge gap, an interdisciplinary team at the University of North Carolina Lineberger Comprehensive Cancer Center developed a clinical trial of antidepressant treatment in cancer patients with major depressive disorder. We describe our experience in our article “A Pilot Study to Evaluate Symptom-Oriented Selection of Antidepressants in Patients with Cancer.”
The challenges of conducting an antidepressant trial in patients with serious medical illness are formidable but not insurmountable. Lessons from our experience may help future researchers design and implement interdisciplinary supportive care and palliative medicine trials. We suggest that future researchers interested in the intersection of palliative medicine and psychiatry define their target psychiatric symptoms with as much clarity as possible. If investigators wish to study major depressive disorder, then wide screening and a high threshold for eligibility are needed to accurately capture the target disease. Alternatively, palliative medicine researchers may be more interested in a targeted symptom reduction approach for which clusters of psychiatric symptoms need to be clearly defined and tracked. 5
A more modern, expansive role of palliative medicine includes psychiatry as part of symptom-oriented care. Future research focused on symptom management, like our study mentioned above, will further integrate these fields.