There is a subset of long-term survivors that have low mood but it may be a presentation more consistent with prolonged grief disorder (PGD) that we may be missing. These patients get referred for depression, but prolonged grief is a different experience requiring different treatment approaches. Alternatively, they may not be recognized as having a problem because their cancer may be in remission or stable. Meanwhile, they still mourn who they used to be and what they used to be able to do.

Some patients with PGD have higher risk of suicidal ideation and attempts and do not respond well to antidepressant treatment. They are also present more frequently to the ER, get admitted more often and stay longer. There is a need to raise awareness that some treatment resistant depression cases may actually have PGD and would in turn benefit more from psychotherapeutic interventions. However, since they are mourning the loss of their former selves, they do not meet the current definition of PGD. There is a need to screen for PGD in addition to screening for depression. Patients with PGD would benefit from psychotherapy, as several different modalities have demonstrated benefit.