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Understand the risk factors for suicide in cancer patients
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A diagnosis of cancer can be life-threatening and life-altering. Its treatment can be physically and psychologically traumatic, causing high levels of distress that can put a patient at risk for developing psychopathology. This, in turn, places the patient at increased risk of suicide. Although the incidence of suicidal ideations in a cancer population is similar to that of the general population, the incidence of suicide can be as much as 10 times higher. The most common method of suicide in these patients is overdose with painkillers and sedatives; the most common location for these deaths is at home.
With a better understanding of the factors contributing to cancer patients’ risk for committing suicide, cancer professionals can identify and treat when possible. The same risk factors that put someone in the general population at risk for suicide also hold true for patients with cancer. In addition, there are also cancer-specific risk factors that cancer professionals need to know.
A recent analysis of the literature on the risk for suicide in cancer patients identified the most prominent cancer-specific risk factors to be poor physical functioning, poor prognosis or advanced disease and time since diagnosis. Although most of the studies examined identified the acute phase after diagnosis as putting cancer patients at highest risk for suicide, two studies showed the risk of completed suicide to extend over time. Two studies in Asia also showed an increased risk for suicide in cancer patients during the first 30 days after discharge from an acute hospitalization.
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It is important to continually assess patients who are at increased risk for suicide. This includes asking about feelings of hopelessness, depression and pain, and other troubling symptoms. For at-risk patients, it is important to determine their mental and emotional response at each crisis point during the cancer trajectory. When appropriate, ask about suicidal ideations and whether the patient has a plan. Multidisciplinary involvement to provide sources of support for the patient can be helpful.
For suicidal patients, it is important to treat depression and control pain and other symptoms. Other treatment considerations include limiting quantities of medications that are lethal in overdose, having frequent contact with a health care professional who can observe and assess the patient, avoiding long periods of time when the patient is alone and ensuring that the patient has support.
Although cancer patients do not have a higher risk of suicidal thoughts when compared with the general population, they do have a higher incidence of suicide. Early recognition of specific identifiable risk factors is the key to prevention and intervention.
Christine A. Zawistowski, MD, is an assistant professor of pediatrics in the division of critical care at Mount Sinai Kravis Children’s Hospital, New York.
For more information:
- Robson A. Psycho-Oncology. 2010;doi:10.1002/pon.1717.