Suicide and Suicidal Thoughts in Cancer Patients

Association between Psychological Suffering and Suicidal Thinking in Patients with Urologic Cancer Using Real-World Data

Cancer is a leading cause of death in Korea, and depression and suicide are major psychiatric problems in cancer patients. This study aimed to explore the correlation between anxiety, depression, social support, cancer state, and suicidality among urologic cancer patients. Sixty patients with urologic cancer were admitted to a university hospital between October 2019 and February 2020. The patients were evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, Suicidality module of the Mini International Neuropsychiatric Interview (MINI), and the Lubben Social Network scales (LSNS). To determine which psychological or demographic factors affected suicide risk, Fisher's exact test, Wilcoxon rank-sum test, regression, and logistic regression were conducted. It was found that the greater the depressive symptoms, the higher the suicidal risk (OR = 1.32, 95% CI = 1.08-1.61). Furthermore, anxiety symptoms and the duration of cancer after diagnosis significantly increased depressive symptoms (p = 0.032). Clinicians should be able to identify the risk factors for suicide in patients with cancer, one of which is depression. To assess the risk of suicide, we must evaluate not only depressive symptoms but also the related anxiety and duration of the disease. Prevention and intervention efforts are needed to improve depressive moods and anxiety after cancer diagnosis.

Suicidal ideation and attempted suicide among cancer patients during the COVID-19 pandemic

This study aimed to understand the suicidal ideation and suicidal attempts among cancer patients during the COVID-19 pandemic. The data were collected from patients diagnosed with cancer while attending the largest cancer center in the south of China. A structured questionnaire was used to investigate patients' demographic data, suicidal behavior, and factors related to COVID-19. Mental health conditions were measured by the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Brief Symptom Inventory. Comorbidities and medical conditions of cancer patients were extracted from the electronic healthcare records. Among the 5670 cancer patients, 755 (13.3%) reported suicidal ideation, and 266 (4.7%) reported suicidal attempts during the COVID-19 pandemic. The age group with the highest risk of suicidal ideation was 20-24 years (23.9%). Lifetime history of suffering from mental disorders, longer time since cancer diagnosis, regional and distant tumor stage, depression, anxiety, hostility, having a higher frequency of worrying about cancer management due to COVID-19, higher frequency feeling of overwhelming psychological pressure due to COVID-19, having a higher level of barriers to manage cancer due to COVID-19, and higher barriers to continue treatment of cancer due to inconveniences caused by COVID-19, were all significantly associated with increased risk of suicidal ideation. We also identified the risk factors of suicide attempts. This is the first study investigating the prevalence and risk factors associated with suicidal ideation and suicidal attempts in Chinese cancer patients during the COVID-19 pandemic. Our findings suggest that it is essential to monitor the mental health conditions of this vulnerable population, especially for cancer patients who have comorbidity with a history of mental disorders. Also, government policymakers should take action to protect cancer patients to avoid any interruption of their continued treatment. Further efforts are urgently required to develop specific psychological interventions to reduce the risk factors among cancer patients during the COVID-19 pandemic.

Risk factor analysis and nomogram construction for predicting suicidal ideation in patients with cancer

BACKGROUND

Suicidal ideation in cancer patients is a critical challenge. At present, few studies focus on factors associated with suicidal ideation, and predictive models are still lacking. This study aimed at investigating the risk factors for suicidal ideation among cancer patients, and developed a predictive nomogram to screen high risk cancer patients for early prevention and intervention.

METHODS

A questionnaire survey was conducted among cancer patients between May 2021 and January 2022. The factors associated with suicidal ideation were used to construct a multivariate logistic regression model, which was visualized as a predictive nomogram to evaluate the risk of suicidal ideation. Areas under the curve, calibration plot, decision curve analysis, and internal and external validation were used to validate the discrimination, calibration and clinical usefulness of the model.

RESULTS

A total of 820 patients with cancer were recruited for this study and 213 (25.98%) developed suicidal ideation. Levels of demoralization, depression and cancer staging, marital status, residence, medical financial burden, and living condition were influence factors for suicidal ideation. Comparing nomogram with Self-rating Idea of Suicide Scale (SIOSS), the nomogram had a satisfactory discrimination ability with an AUC of 0.859 (95% CI: 0.827-0.890) and 0.818 (95% CI: 0.764-0.873) in the training and validation sets, respectively. The calibration plot and decision curve analysis revealed that this nomogram was in good fitness and could be beneficial in clinical applications.

CONCLUSIONS

Suicidal ideation is common in cancer patients. Levels of demoralization, depression and cancer staging were independent predictors of suicidal ideation. The nomogram is an effective and simple tool for predictive suicidal ideation in cancer patients.

Predictive value of the Distress Thermometer score for risk of suicide in patients with cancer

PURPOSE

This study aimed to assess the association between the Distress Thermometer (DT) score and risk of suicide in patients with cancer. In addition, we aimed to determine the best cutoff score to predict patients at risk of suicide.

METHODS

From 2015 to 2016, we retrospectively collected data on patients with cancer. DT scores were collected, and the association between DT score and risk of suicide (suicide ideation or death ideation) was analyzed. Furthermore, receiver operating characteristic (ROC) analysis was performed to identify the appropriate cutoff score for predicting risk of suicide.

RESULTS

A total of 260 patients with cancer were included, and suicidal ideation was identified in 33 cases referred for psychological intervention. The DT scores of the patients with suicidal ideation were significantly higher than those of patients without suicidal ideation (6.30±2.11 vs. 4.29±1.72, p<0.05). In addition, the area under the ROC curve for predicting risk for suicide was 0.758. The cutoff DT score of 3 had the highest sensitivity of 1.00 to rule out suicidal ideation, while 9 had the highest specificity of 1.00 to rule in suicidal ideation. Moreover, the appropriate cutoff DT score to predict patients with suicidal ideation was 5, with a sensitivity of 0.52, specificity of .84, positive likelihood ratio of 3.24, and negative likelihood ratio of 0.58.

CONCLUSION

The DT score may be a helpful clinical tool to evaluate emotional distress and risk of suicide in patients with cancer. Clinically, for DT scores greater than 5 in patients with cancer, the risk of suicide greatly increases. In view of the DT's widespread use internationally by non-mental health clinicians in cancer to guide the need for specialist mental health interventions, its potential utility in also predicting suicide risk is of great interest.

Incidence of suicide among adolescent and young adult cancer patients: a population-based study

Background

As the survival rates of cancer patients continue to increase, most cancer patients now die of non-cancer causes. Several studies have been showing elevated suicide rates among patients with cancer. However, no large-scale study has thoroughly assessed the risk of suicide among adolescent and young adult (AYA) patients with cancer. This study was conducted to characterize suicide mortality among AYA patients in the US and identify risk factors associated with a higher risk of suicide.

Methods

Patients aged 15–39 years were residents of the US served by the Surveillance, Epidemiology, and End Results (SEER) program, who were diagnosed with cancers from 1973 to 2015.

Results

We report that 981 of the 572,500 AYA patients with cancer committed suicide, for an age-, sex-, and race-adjusted suicide rate of 17.68/100,000 person-years. The rate of suicide was 14.33/100,000 person-years in the corresponding general population, giving a standardized mortality ratio (SMR) of 1.234 [95% confidence interval (CI) 1.159–1.313]. Higher suicide rates were associated with male sex, white race, unmarried state, distant tumor stage, and single primary tumor. AYA patients with otorhinolaryngologic, gonad, stomach, soft tissue, and nasopharyngeal cancer were at the greatest risk of suicide compared with those with other types of cancer. In older patients (≥ 40 years), the risk was highest in those with lung, stomach, oral cavity and pharynx, larynx, and bone malignancies. SMRs were highest in the first 5 years after diagnosis for most types of cancer.

Conclusion

AYA patients with cancer in the US have over 20% higher the incidence of suicide of the general population, and most suicides occurred in the first 5 years following diagnosis. Suicide rates vary among patients with cancers of different anatomic sites. Further examination of the psychological experience of these young patients with cancer, particularly that of those with certain types of cancer, is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12935-021-02225-y.

Exploring the problems faced by patients living with advanced cancer in Bengaluru, India

Purpose

Cancer is a key influence on psychosocial and emotional distress among patients. Problems that advanced cancer patients in the western world face have been widely explored, but these findings may not be applicable in the non-western world due to the cultural differences. Exploring the problems of advanced cancer patients will help professionals plan appropriate therapeutic interventions to take care of the patients' physical, emotional, social and practical needs. Hence, this study aims to explore the psychosocial and emotional problems of advanced cancer patients in India.

Methods

Data were collected from 10 advanced cancer patients from Bengaluru, using purposive sampling and semi-structured interviews. The interviews were audio-recorded and transcribed. Themes were generated using thematic analysis.

Results

The prevalent themes were financial instability, hopelessness, family anguish, self-blame, helplessness, anger, stress, and suicidal thoughts.

Conclusion

This research has highlighted that advanced cancer patients have several issues, indicating the importance of using a holistic approach while handling this vulnerable population by focusing more on the patient rather than the disease.

[Cancer and suicide among the elderly: psychosocial determinants of risks, psychopathology and opportunities for prevention]

Suicide is a serious public health problem worldwide. Increasing age is directly associated with the rising rates of cancer and physical and functional limitations are important factors regarded as being associated with suicidal behavior among the elderly. This study sought to conduct a critical review of the literature on the risk factors associated with suicide among elderly cancer patients published between 2000 and 2015. Psychosocial precipitants of risks and psychopathology in 20 selected articles were conducted. The studies consistently identified a number of factors that have been considered to be associated with suicidal behavior among the elderly diagnosed with cancer. These include physical and mental health constraints (particularly major depression), social isolation, and the manner in which these factors and others interact. Further research is needed given the importance of the issue and to examine whether further education for healthcare providers and their abilities in suicide risk assessment and management could have positive effects on reducing the suicide rates among elderly patients with cancer. Considerations for upcoming studies encourage the adoption of empirically supported interventions for individualized management of the elderly cancer patient.

Increasing suicide risk among cancer patients in Lithuania from 1993 to 2012: a cancer registry-based study

Certain groups of individuals seem to have an increased risk of committing suicide, and a number of studies have reported an increased risk of suicide among cancer patients. In this study, we aim to estimate the risk of suicide among cancer patients in Lithuania over the period 1993-2012. The records of patients diagnosed with primary cancer were extracted from the population-based Lithuanian Cancer Registry and 273 511 cases of first cancer were included in the analysis. Sex, age and calendar period-standardized mortality ratios (SMRs) were calculated by dividing the observed numbers of suicides among cancer patients by the expected number using national rates. An increased suicide risk was found for both sexes combined [SMR=1.31, 95% confidence interval (CI): 1.21-1.41] compared with the general population. For all cancer sites except melanoma and skin, and breast and thyroid cancers, the relative suicide risk was elevated. The suicide risk was almost three-fold higher for advanced-stage patients compared with the general population (SMR=2.89, 95% CI: 2.24-3.73). The highest suicide risk observed in our study was during the first 3 months following cancer diagnosis (SMR=2.43, 95% CI: 1.96-3.01), indicating a critical period shortly after diagnosis. Despite ongoing increases in survival among cancer patients and decreases in suicide mortality in the general Lithuanian population during our study period, the increasing risk for suicide indicates that cancer patients' clinical and psychosocial needs remain unsatisfied. The major clinical implication of these data suggests the importance of multidisciplinary preventive interventions.

Association of chronic disease prevalence and quality of life with suicide-related ideation and suicide attempt among Korean adults

AIMS

The aim of this study is to find the association of chronic disease prevalence (CDP) with suicide-related ideation (SI) and suicide attempt (SA) and to determine the combined effect of CDP and quality of life (QoL) with SI or SA.

DESIGN

This was a cross-sectional study.

MATERIALS AND METHODS

The data were collected from the nationally representative Korea National Health and Nutrition Examination Survey IV and V (2007-2012). For the analysis, a total of 35,075 adult participants were selected as the final sample, which included 5773 participants with SI and 331 with SA.

STATISTICAL ANALYSIS

Multiple logistic regression models were used to examine the odds ratio after adjusting for age, sex, marital status, education, occupation, and household income.

RESULTS AND CONCLUSION

SI was positively associated with selected CDP, such as cardiovascular disease (CVD), stroke, ischemic heart disease (IHD), cancer, diabetes, renal failure, and depression, except hypertension. Subjects with CVD, IHD, renal failure, and depression were found likely to have increased odds for SA as compared to non-SA controls. Lower QoL strongly affected SI and SA. Furthermore, the likelihood of SI increased for depressed and cancer subjects who had low QoL in comparison to subjects with high QoL and without chronic disease. Similarly, statistically, significant interaction was observed between lower QoL and depression in relation to SA compared to non-SA controls. These data suggest that suicide-related behavior could be predicted by the prevalence of chronic disease and low QoL.

Assessing Suicidal Ideation and Behaviors Among Survivors of Childhood Brain Tumors and Their Mothers During Sociobehavioral Research

PURPOSE/OBJECTIVES

To describe the development and feasibility of a protocol for nonpsychiatric subspecialty research staff members to screen research participants who endorse suicidal ideations or behaviors during data collection
.

DESIGN

Descriptive protocol development.
.

SETTING

The Children's Hospital of Philadelphia and the University of Pennsylvania.
.

SAMPLE

186 mother caregivers and 134 adolescent or young adult survivors of childhood brain tumors, with the protocol implemented for 5 caregivers and 11 survivors.

METHODS

During telephone- and home-based interviews, the interviewer assessed the participant using the Columbia-Suicide Severity Rating Scale (C-SSRS).

MAIN RESEARCH VARIABLES

Expressed suicidal ideation or behavior
.

FINDINGS

Implementation of the C-SSRS by nonpsychiatric subspecialty staff members was feasible and valid. Interviewers' conclusions based on this instrument matched those of the mental health professional who followed up with participants. Process notes contained themes about the participants, including anger and sadness in survivors and the physical and emotional demands of the survivor in caregivers. Progress notes for the interviewer included a reiteration of events, whether the assessment was successful, and whether the recommendation of the interviewer was in agreement with that of the mental health professional
.

CONCLUSIONS

The protocol based on the C-SSRS was useful and feasible for nonpsychiatric subspecialty staff members to use in the collection of data from survivors of childhood brain tumors and their caregivers.

IMPLICATIONS FOR NURSING

Survivors of childhood brain tumors and their caregivers may experience psychosocial distress. Nurses, as research assistants or in other roles, can use tools such as the C-SSRS to assist in front-line assessments. 
.

Incidence and risk factors for suicide and attempted suicide following a diagnosis of hematological malignancy

Solid tumors are associated with an increased risk of suicide, however, there is limited detailed information on the risk of suicide in patients with hematological malignancies. Therefore, we conducted a population-based study including 47,220 patients with hematological malignancies (diagnosed 1992-2006) and their 235,868 matched controls to define the incidence and risk factors for suicide and suicide attempt. Information on suicides, suicide attempts, and preexisting psychiatric disorders was obtained from Swedish registers and individual medical records. There was a twofold increased (hazard ratio [HR] = 1.9, 95% confidence interval 1.5-2.3, P < 0.0001) risk of suicide/suicide attempt during the first 3 years after diagnosis in patients with hematological malignancies compared to matched controls. Of all hematological malignancies, multiple myeloma was associated with the highest risk (HR = 3.4; 2.3-5.0, P < 0.0001). Patients with a preexisting psychiatric disorder were at a very high risk of suicide and suicide attempt (HR = 23.3; 16.6-32.6, P < 0.0001), regardless of type of hematological malignancy. Among patients who committed suicide, 19% were in a palliative phase and 44% were in remission with no active treatment. In conclusion, the risk of suicide and suicide attempt is elevated in patients with hematological malignancies. Certain high-risk patients may benefit from early detection and preventive measures.

Suicidal ideation and suicide attempts in anxious or depressed family caregivers of patients with cancer: a nationwide survey in Korea

Purpose

To describe the prevalence of suicidal ideation and suicide attempts in family caregivers (FCs) of patients with cancer and to identify the factors associated with suicidal ideation and suicide attempts in FCs with anxiety or depression.

Methods

A national, multicenter survey administered to 897 FCs asked questions concerning suicidal ideation and suicide attempts during the previous year and assessed anxiety, depression, socio–demographic factors, caregiving burden, patient factors, and quality of life (QOL).

Results

A total of 17.7% FCs reported suicidal ideation, and 2.8% had attempted suicide during the previous year. Among FCs with anxiety, 31.9% had suicidal ideation and 4.7% attempted suicide; the corresponding values for FCs with depression were 20.4% and 3.3%, respectively. Compared with FCs without anxiety and depression, FCs with anxiety or depression showed a higher adjusted odds ratios (aOR) for suicidal ideation (aOR  = 4.07 and 1.93, respectively) and attempts (OR  = 3.00 and 2.43, respectively). Among FCs with anxiety or depression, being female, unmarried, unemployed during caregiving, and having a low QOL were associated with increased odds of suicidal ideation. FCs with anxiety who became unemployed during caregiving constituted a high-risk group for suicide. Being unmarried and having a low QOL with respect to financial matters were associated with increased suicide attempts among FCs with depression.

Conclusion

FCs with anxiety or depression were at high risk of suicide. Interventions to enhance social support and to improve perceived QOL may help prevent suicide and manage suicidal ideation in FCs with anxiety or depression.

Comparative Risk Factors for Accidental and Suicidal Death in Cancer Patients

Background: Cancer patients appear at higher risk of accidental death and suicide. The reasons for this and how suicide and accidental death relate remain unclear. Aims: To clarify and contrast risk factors for such deaths among cancer patients. Methods: A SEER (1973–2007) analysis was conducted on 4,449,957 cancer patients comparing all causes of death (COD) to accidental and suicidal deaths through competing hazards, relative risk and proportional hazards models. SEER did not provide psychological assessments; the analysis was confined to their standard epidemiological and clinicopathological parameters. Results: 2,557,385 overall deaths yielded 16,879 (0.66%) accidents and 6,589 (0.26%) suicides. Mortality reached its highest incidence immediately after diagnosis and obeyed Pareto type II distributions. The major identifiable risk factor for suicide was male gender; for accidental death, First Nations ethnicity; and all COD, metastases. Minor factors for suicide included metastases, advanced age, and respiratory as well as head and neck tumors, whereas for accidental death they were male gender, metastases, advanced age, and brain tumors. Conclusions: Differences were observed in the risk patterns of suicide and accidental death, suggesting distinct etiologies. A high incidence of suicides and accidental deaths following diagnosis (attributed by some to stress from the diagnosis of cancer) correlated here with overall mortality and indicators of physical morbidity. Cancer patients with the above identifiable risk factors warrant supportive attention.

Assessing the risk for suicide in patients with cancer

The Joint Commission publishes its annual National Patient Safety Goals to guide accredited organizations in addressing high-risk, low-volume concerns related to patient safety. The 2010 list includes a goal to identify patients at risk for suicide, but do oncology nurses need to be concerned about the risk of suicide in patients with cancer?

Factors of early suicide after discharge: a national linkage study for suicide victims in Taiwan

Patients recently discharged from psychiatric inpatient care have a higher suicide rate. The study aimed to identify the characteristics associated with early suicide of those patients discharged from psychiatric wards in Taiwan. The results indicated that among 672 suicide victims who died within one year post-discharge from psychiatric wards in Taiwan between 2000 and 2004, diagnosis of schizophrenia, shorter disease duration, and co-morbidity with cancer were all significantly associated with suicide occurring within one month of discharge. Clinical diagnosis of psychiatric disorders, recent psychiatric diagnosis, and co-morbidity with severe physical illnesses should receive special monitoring for potential suicide after discharge.

Gender differences in factors associated with suicidal ideation in major depression among cancer patients

OBJECTIVE

Major depression is a well-documented risk factor for suicide, and several gender differences in risk factors for suicide exist in cancer patients as well as in the general population. However, no data is available regarding gender differences in risk factors for suicide among cancer patients with major depression.

METHODS

We investigated the background differences between cancer patients suffering from major depression with or without suicidal ideation according to gender by analyzing the consultation data obtained for patients referred to the Psychiatry Division.

RESULTS

Among the 5431 referred patients, 329 males and 399 females were diagnosed as having major depression; among these patients with major depression, 136 (41%) males and 157 (39%) females also had suicidal ideation. A preliminary analysis showed that physical functioning and an advanced stage were potential factors that interacted significantly with gender differences regarding suicidal ideation. A final logistic regression analysis indicated that poor physical functioning and an advanced stage were significant risk factors among male patients.

CONCLUSIONS

These preliminary findings suggest that gender differences in important indicators of suicidal ideation exist among cancer patients with major depression; these findings may be useful for developing strategies to prevent suicide among cancer patients.

Suicide ideation in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

PURPOSE

To evaluate risk of suicide ideation (SI) after childhood cancer, prevalence of SI in a cohort of adult survivors of pediatric cancers was compared with prevalence in a sibling comparison group. The relationship of SI to cancer treatment and current health was examined, and the hypothesis that poor physical health is significantly associated with suicidality, after adjusting for depression, was specifically tested.

METHODS

Nine thousand one hundred twenty-six adult survivors of childhood cancer and 2,968 siblings enrolled onto the Childhood Cancer Survivor Study completed a survey describing their demographics and medical and psychological functioning, including SI in the prior week.

RESULTS

Of survivors, 7.8% reported SI compared with 4.6% of controls (odds ratio = 1.79; 95% CI, 1.4 to 2.4). Suicidality was unrelated to age, age at diagnosis, sex, cancer therapy, recurrence, time since diagnosis, or second malignancy. SI was associated with primary CNS cancer diagnosis, depression, and poor health outcomes including chronic conditions, pain, and poor global health rating. A logistic regression analysis showed that poor current physical health was significantly associated with SI even after adjusting for cancer diagnosis and depression.

CONCLUSION

Adult survivors of childhood cancers are at increased risk for SI. Risk of SI is related to cancer diagnosis and post-treatment mental and physical health, even many years after completion of therapy. The association of suicidal symptoms with physical health problems is important because these may be treatable conditions for which survivors seek follow-up care and underscores the need for a multidisciplinary approach to survivor care.

Better Off Dead: Suicidal Thoughts in Cancer Patients

Purpose

Cancer is associated with an increased risk of suicide and attempted suicide. However, we do not know how many cancer patients have thoughts that they would be better off dead or thoughts of hurting themselves. This study aimed to determine the prevalence of such thoughts in cancer outpatients and which patients are most likely to have them.

Patients and Methods

A survey of consecutive patients who attended the outpatient clinics of a regional cancer center in Edinburgh, United Kingdom. Patients completed the Patient Health Questionnaire-9 (PHQ-9), which included Item 9 that asks patients if they have had thoughts of being better off dead or of hurting themselves in some way in the previous 2 weeks. Those who reported having had such thoughts for at least several days in this period were labeled as positive responders. Patients also completed the Hospital Anxiety and Depression Scale (HADS) and a pain scale. The participating patients’ cancer diagnoses and treatments were obtained from the cancer center clinical database.

Results

Data were available on 2,924 patients; 7.8% (229 of 2,924; 95% CI, 6.9% to 8.9%) were positive responders. Clinically significant emotional distress, substantial pain, and—to a lesser extent—older age, were associated with a positive response. There was strong evidence of interactions between these effects, and emotional distress played the most important role.

Conclusion

A substantial number of cancer outpatients report thoughts that they would be better off dead or thoughts of hurting themselves. Management of emotional distress and pain should be a central aspect of cancer care.

Suicide and cancer: a gender-comparative study

BACKGROUND

Persons with cancer commit suicide more frequently than those without, and males generally commit suicide more frequently than females. A population-based analysis of cancer patients was carried out here, comparing suicide risk between the genders, to elucidate the features specific to each gender.

PATIENTS AND METHODS

A total of 1.3 million cancer cases from the Surveillance, Epidemiology, and End Results program were analyzed. Cox proportional hazards models were fitted to personal, tumor-related, and social variates.

RESULTS

A total of 265 female and 1307 male suicides were enumerated, reflecting 0.04% and 0.19% from each gender, and providing an overall hazard ratio for male suicide of 6.2 [95% confidence interval (CI) 5.4-7.1]. Females with colorectal (P = 0.01) and cervical (P < 0.0001) cancers showed decreased suicide rates. Males with head and neck cancers (P < 0.0001) and myeloma (P = 0.02) had increased rates, whereas rates were decreased in males with lung cancer (P = 0.01), liver (P = 0.01), brain tumors (P = 0.04), and leukemia (P = 0.007). The hazard ratio associated for male suicide with distant metastasis was 2.84 (95% CI 2.49-3.24); for married status, 0.46 (95% CI 0.39-0.54); and for African-American ancestry, 0.24 (95% CI 0.17-0.34)-comparable ratios were seen here for female suicides. In head and neck cancers, with both genders analyzed together, the suicide hazard was increased if surgery was contraindicated (3.0, 95% CI 1.3-6.8), but not if refused.

CONCLUSIONS

The high-risk patient was male, with head and neck cancer or myeloma, advanced disease, little social or cultural support, and limited treatment options. Oncologists and allied health professionals should be aware of the potential for suicide in cancer patients and their associated risk factors.

The role of physical and psychological symptoms in desire for death: a study of terminally ill cancer patients

The current study assessed the attitudes of the desire for hastened death in terminally ill cancer patients and whether these are determined by their physical and psychological symptoms. The final sample consisted of 106 terminally ill cancer patients attending a Palliative Care Unit, in University of Athens, Greece, between June and October 2004. Significant associations were found between the desire for hastened death (D.H.D.) and 'pain' (r=0.469, p<0.005), 'fatigue' (r=0.591, p<0.0005), 'loss of appetite' (r=0.622, p<0.0005) and 'feeling sad' (r=0.635, p<0.0005). Statistically significant associations were also found between Schedule of Attitudes towards Hastened Death (SAHD) scores, age (r=0.300, p=0.002) and ECOG (p<0.0005). Twenty-six percent of the patients reported high D.H.D. while 41% reported moderate desire. In the prediction of SHAD the contribution of 'pain' (p=0.011), 'lack of appetite' (p=0.012) and 'sadness' (p=0.011) is high (42% of variance). Further findings suggest that D.H.D. is significantly related to 'feeling sad', 'lack of appetite', 'pain' and 'fatigue' after controlling for age, gender and performance status according to ECOG in terminally ill cancer patients.

Suicidal ideation and attempts in adult survivors of childhood cancer

PURPOSE

This study examined the prevalence of suicidal ideation and past suicide attempt in adult survivors of childhood cancer and investigated the relationship of suicidal symptoms to cancer treatment and current health. The hypothesis that poor physical health would be significantly associated with suicidality after adjusting for mental health variables was specifically tested.

METHODS

Two hundred twenty-six adult survivors of childhood cancer (mean age, 28 years) seen in a survivor clinic completed the Short Form-36 and the Beck Depression Inventory (BDI), as well as suicide items from the Symptom Checklist-90 Revised, and Beck Scale for Suicide Ideation. Participants reporting current suicide ideation or any past suicide attempt were classified as suicidal.

RESULTS

Twenty-nine participants (12.83%) reported suicidality, although only 11 of these were significantly depressed by BDI criteria. Univariate analyses found suicidality unrelated to age or sex but positively associated with younger age at diagnosis, longer time since diagnosis, cranial radiation treatment, leukemia diagnosis, depression, hopelessness, pain, and physical appearance concern. A hierarchical logistic regression showed that current physical functioning, including pain, was significantly associated with suicidality even after adjusting for treatment and depression variables.

CONCLUSION

Suicidal symptoms, which are reported by a significant minority of adult survivors of childhood cancer, are related to cancer treatments and post-treatment mental and physical health. Association of suicidal symptoms with physical health problems is important because these represent treatable conditions for which survivors may seek follow-up care. The relationship of physical well-being to suicidality underscores the need for a multidisciplinary approach to survivor care.

Suicide mortality is decreasing among cancer patients in Central Italy

The objective of this study was to discover whether suicide mortality among patients diagnosed with cancer during the period 1985-1999 had decreased with calendar time in comparison to the rate in the general population. 90?197 cancer patients resident in Tuscany, Central Italy and incident during the period 1985-1999 were followed up for life status to 31 December 2000. The mortality codes for suicide were considered (E950-E959). Time trends for suicide rates were assessed by using Kernel smoothing estimators, standardised mortality ratios and Poisson analysis of the observed/expected ratios. The standardised mortality ratios were 324, 224, and 185 for cancer patients diagnosed during the periods 1985-1989, 1990-1994, and 1995-1999, respectively. Tests for linear trends were borderline significant (P=0.053). Suicide mortality among cancer patients in central Italy had decreased with calendar time relative to the suicide trend in the general population. Improved treatment options and better communication of diagnosis are possible explanations of this finding.

The surgical management of elderly cancer patients

Although cancer in the elderly is extremely common, few health professionals in oncology are familiar with caring for series of oncogeriatric patients. Surgery is at present the first choice, but is frequently delivered suboptimally: under-treatment is justified by concerns about unsustainable toxicity, whilst over-treatment is explained by the lack of knowledge in optimising preoperative risk assessment. This article summarises the point of view of the Surgical Task Force @ SIOG (International Society for Geriatric Oncology), pointing out differences from, and similarities to, the younger cohorts of cancer patients, and highlighting the latest updates and trends specifically related to senior cancer patients.

Suicidality in terminally ill Japanese patients with cancer

BACKGROUND

The risk of suicide is higher in patients with cancer than in the general population, making end-of-life care of suicidal terminal patients with cancer critical. To identify factors and longitudinal changes associated with suicidality among terminally ill Japanese patients with cancer, a prospective cohort study was performed.

METHODS

Consecutive outpatients with cancer who registered with a palliative care unit participated. Structured interviews (e.g., Structured Clinical Interview for DSM- III-R [SCID]) were conducted to assess patient suicidal ideation (Ideation) and interest in requesting euthanasia (Interest) as main outcome measures of suicidality. Possible correlated factors also were investigated. The authors analyzed the data from 140 terminally ill patients with cancer at initial study participation (baseline) whose subsequent survival time was < 6 months. Of these 140 patients, 57 (40.7%) completed the follow-up assessment after admission to the unit.

RESULTS

At baseline, 8.6% of the patients had Ideation and 5.0% had Interest. Self-reported anxiety and depression was significantly associated with Ideation (P= 0.003). Changes in Ideation and Interest occurred in 38.6% and 15.8% of the patients, respectively. Ideation was more likely to change than Interest (P = 0.006). The current study did not identify factors that predict changes and occurrences of suicidal ideation and interest in requesting euthanasia.

CONCLUSIONS

Suicidality can change even in terminally ill patients. End-of-life care that focuses on the psychologic distress of dying individuals may be a way of preventing suicide.