There is no clear way of defining how much psychological distress can be considered "normal" in a dying person.

The identification of those cancer patients who may benefit from psychotherapy (and/or psychotropic medication) depends essentially on the knowledge and sensitivity of those (relatives and doctors/nurses) already caring for them at home or in the hospital.

In general, any psychological distress which is persistent and interferes with the patient's ability to function as well as their illness will allow, should be considered for treatment (because some of them will be found to be completely reversible and much can be relieved).

By far, the most frequent psychiatric diagnoses applicable to severe cancer patients (who are facing death in the near future) is adjustment reaction. Depressive and easily excited types, acute paranoid reactions and reactive confusion are also frequently seen.

Also common are symptoms that can be caused by cerebral secondary tumours or by the drug used to control the primary cancer itself.

Thus management of the symptoms depends on accurate identification of the problem and its causes.

Where there is little possibility for change within the patient, helping the family (or other care givers) to understand the problem and to manage it in the best way eases much of the stress on them.

But remember that it is never possible, nor would it be desirable, to relieve all the emotional suffering in patients (and families) coping with terminal illnesses.

The aim of intervention should be to relieve all unnecessary and disabling symptoms so that the work of anticipatory grieving can be accomplished leaving everyone concerned able to function as well as possible.