A new Canadian study reports that terminal cancer patients who are aware they are going to die are less likely to be depressed than others who are still in denial of their impending death.

The author of the study, published in an upcoming issue of the journal Psychosomatics, interviewed 200 patients with advanced cancer who were in their final weeks of life at 2 Winnipeg palliative care units. The patients, aged 31 to 94, were asked about their level of awareness of their prognosis, depressive disorders and demographic and social variables.

"We found that depression was about 3 times greater among patients who didn’t acknowledge their terminal prognosis," said the author of the study, Dr. Harvey Chochinov of the University of Manitoba. "Denial may be a defense mechanism used by some patients to protect themselves from death anxiety, but our findings show that it is often imperfect and doesn’t necessarily eliminate underlying psychological distress."

The study found:

• 9.5% of dying cancer patients were in denial of both their terminal prognosis and less than 6-month life expectancy
• 17% had partial awareness
• 73.5% were completely aware

Dr. Chochinov, a professor of psychiatry, family medicine and palliative care, added the study contains important lessons for physicians who need to recognize that if a patient is unable to express awareness of their prognosis and life expectancy he or she may also be battling with profound psychological distress.

"Quality of care for cancer patients in the terminal stages of their disease is extremely important and quite often not enough attention is given to this stage of the disease," said Dr. Barb Whylie, director of medical affairs at the Canadian Cancer Society, which helped fund the study. "These findings will help us better understand what happens when people face a terminal prognosis, an unfortunate reality for many cancer patients.