Amy ZhangCase Western Reserve University nurse scientist Amy Zhang, who has long examined quality-of-life issues in cancer patients, wondered whether depression in African-American cancer patients has been under-recognized for treatment.

Accurately assessing depression in cancer patients is difficult in general because the physical symptoms of cancer and depression—low energy, lack of sleep and loss of appetite—are so similar.

“African-American cancer patients are often sicker and have more severe physical symptoms,” said Zhang, an associate professor at Case Western Reserve’s Frances Payne Bolton School of Nursing. “So I wanted to see if something was missing in how and what we were asking patients.”

Among other important implications, identifying and treating depression in cancer patients is critical because those with a more optimistic outlook tend to live longer.

Zhang and her colleagues studied 74 cancer patients (34 depressed and 23 non-depressed African-Americans and 17 depressed Caucasians) at a Northeast Ohio medical center, hoping to identify depression symptoms in black cancer patients through group comparisons.

The participants had been diagnosed with early-stage breast or prostate cancers within the previous three years and were at least six months from their last treatment. They were asked a series of open-ended questions to measure depression.

Depressed African-American patients reported feeling irritable and wanting to be alone more frequently than non-depressed black patients—symptoms not usually described on the diagnostic test for depression. They also reported more insomnia, fatigue and crying.

Researchers also found that depressed African-American patients reported sad feelings less often than depressed Caucasian patients. Many black cancer patients didn’t use the word “depressed” to describe how they’re feeling, using instead such words as “feeling down,” “gloomy,” “low” or “blue.”

“Because we don’t use those words in standardized testing, we could be losing people with depression,” Zhang said.

Their conclusion: Standard psychological tests are mainly based on responses from white patients. Therefore, black cancer patients may benefit from more culturally sensitive depression measures that consider irritability, social isolation and describing a down mood in ways other than feeling “depressed.

Given new clues to depression in black cancer patients may allow clinicians to more accurately diagnose and treat the disorder by asking new questions that specifically target such symptoms, Zhang said.

Next, Zhang hopes to begin testing a larger number of participants to see if using new culturally sensitive questions and descriptions of symptoms result in better diagnosis of—and treatment for—black cancer patients with depression.

Findings from the pilot study, conducted from 2006-09 and funded by the National Institute of Cancer of the National Institutes of Health (R03 CA115191-01A2), were recently posted online in the Journal of Mental Health article, “Exploration of depressive symptoms in African American cancer patients.”

Faye Gary, the Medical Mutual of Ohio Kent W. Clapp Chair and professor of nursing at the Frances Payne Bolton School of Nursing, and Hui Zhu, assistant professor of urology at the Case Western Reserve School of Medicine and section urology chief at the Louis Stokes Cleveland VA Medical Center, were co-investigators and co-authors on the study.