1. Introduction

Cancer is considered one of the most life threatening illnesses worldwide, which can be associated with severe psychological burdens on the patients ^[1]. Unsurprisingly, many studies have described the high prevalence of depression in patients with cancer ^{[2, 3, 4, 5]}. For example, reference ^[3] found that depression prevalence rate in cancer patients is 66.72 %, and the prevalence rate differs according to the type of cancer, as the highest rate of depression was found in lung cancer (77.19 %) and esophagus cancer (75.81 %), while slightly lower rates were reported in cervix cancer (71.13 %), liver cancer (68.42 %), head and neck cancer (60.62 %), stomach cancer (63.40 %), breast cancer (57.9 %), and colorectal cancer (54.37 %).

The cancer patients with depression may experience changes in appetite or weight, changes in the sleep pattern and psychomotor activity, feeling sad, feeling worthless, feeling guilt, and in severe cases they have suicidal ideas and frequent thoughts of death ^[6]. In addition, cancer patients with depression may present with loss of energy and interest and hopelessness ^[7]. These symptoms can increase length of hospital stay in cancer patients and increase cost of treatment for those patients.

Literature review revealed that depression is the most common psychiatric symptom in cancer patients ^[2]. Unfortunately, depression is associated with a poorer outcome and can negatively affect the prognosis of cancer ^[5]. If the depression in cancer patients was not treated, the prognosis of cancer will get worse because low mood is associated with low immunity ^[8]. Moreover, in cancer patients, depression is associated with poor quality of life, impairment in the social and occupational functioning, decrease of pain tolerance, and longer hospital stays ^[9]. To prevent all of the previously mentioned negative impacts of depression on cancer patients, health care professionals should use evidence based management modalities for assessment and management of depression in cancer patients. Nurses are directly involved in providing care for depressed cancer patients over the entire course of their illness. However, the nurse role in assessment and management of depression in cancer patients is not clearly defined in the literature. The purpose of this article is to identify the nursing role in assessment and management of depression in cancer patients, and to provide recommendations for future research regarding nursing assessment and management of depression in cancer patients.

2. Methodology

Literature review of relevant articles was conducted using the PubMed and CINAHL electronic databases. Keywords included in search are: “cancer”, “depression”, “nurse”, “assessment”, “management” and a combination thereof. Articles that were not published in English, and articles that were published since more than 10 years were excluded from review. Other articles were not included because of redundant data, and not being directly relevant to the topic of interest.

3. Results

Based on the review of literature, this paper first presents different roles of nurses in assessment and management of depression in cancer patients. Next, the paper provides recommendations for future research regarding nursing assessment and management of depression in cancer patients. The results highlighted different aspects of nursing practice and research.

Nurses can play a vital role in assessment and prevention of depression in cancer patients. The role of nurses in assessment and prevention of depression in cancer patients starts in the initial contact with the patients. First of all, it is important that the nurse should anticipate depression in all cancer patients as a response to cancer diagnosis and symptoms, and as a response to certain treatments that are associated with depression in cancer patients; example of treatments that are associated with depression in cancer patients is the chemotherapy ^[1]. In addition, the nurse should be aware of the other risk factors for depression in cancer patients. According to ^[10], the most important risk factors for depression in cancer patient are the history of previous mental illness, presence of severe painful symptoms, and lack of social support. It is highly recommended that nurses anticipate depression in cancer patients with these risk factors. In addition, there are other factors that can increase the risk of depression in cancer patients such as the high level of pain, low level of education, old age, and poor performance status ^[3]. It is imperative that nurses have good communication skills to be able to elicit patients’ concerns and immediately report any suicide risk to the supervising psychiatrist. However, to accurately assess depression in cancer patients, nurses should utilize specific and valid tools such as Hospital Anxiety and Depression scale ^[11]. It is strongly recommended that nurses should use a valid screening tool for depression in cancer patients as a routine task while providing nursing care. For assessment of depression, using self-evaluation instrument, however, is not adequate; it is important to use a semi-structured clinical interview, especially, for those patients who have scores higher than the cut-off score on self-evaluation instrument which indicates presence of depression. Hospital Anxiety and Depression Scale (HADS) is an example of self-report screening tool with a cut-off score of 8 ^[11]. For diagnosis of depression, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-V-TR) criteria for diagnoses of depression should be used to specify and differentiate between depression as a symptom and depression as a mental disorder ^[12].

Nurses can play a vital role in management of depression in cancer patients. First of all, it is important that nurses be aware about the evidence-based management m