Better Off Dead: Suicidal Thoughts in Cancer Patients

University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, Edinburgh, United Kingdom EH10 5HF.
Journal of Clinical Oncology (Impact Factor: 18.43). 09/2008; 26(29):4725-30. DOI: 10.1200/JCO.2007.11.8844
Source: PubMed


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.
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.
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.
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.

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    • "The latter is a neuroendocrine system that regulates the body’s response to stress and an imbalance in this system can cause mood disorders including suicidal ideation [4, 5]. Cancer patients can be affected, among others, by the mental and physical demands of having the diagnosis as well as stressors that have to do with disease progress and treatment [6]. "
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    • "National Comprehensive Cancer Network's (NCCN) Distress Thermometer as a screening tool u Demographic Factors Older age, male gender, unmarried, and race u Disease Factors High-fatality cancer, higher cancer stage, and point in disease trajectory u Associating Factors Physical symptoms (e.g., pain) and decreased performance status u Psychosocial Factors Preexisting psychopathology, depression, anxiety, hopelessness, substance abuse, family history of suicide, and isolation FIGURE 1. Suicide Risk Factors in Patients With Cancer Note. Based on information from Ahn et al., 2010; Akechi et al., 2002; Bill-Axelson et al., 2010; Emanuel et al., 2000; Filiberti & Ripamonti, 2002; Güth et al., 2011; Johansen et al., 2005; Johnson et al., 2012; Mahdi et al., 2011; Miller et al., 2008; Misono et al., 2008; Robson et al., 2010; Shim & Hahm, 2011; Suarez-Almazor et al., 2002; Turaga et al., 2011; Walker et al., 2008. "
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    • "Psychosocial needs are often unmet in cancer treatment [25] [26] and in cancer treatment centres psychosocial domains (aspects of managing daily life, emotions, and social identity) were among the highest perceived supportive needs for cancer patients in treatment as well as after treatment [27] [28]. Psychosocial issues figure increasingly as the disease progresses [29] and it is found that emotional distress ranged highest in a study focusing on thoughts of suicide in cancer patients [30]. Our study confirms the importance of recognizing needs for psychosocial support as the cancer disease progresses, as for our patients, throughout maybe a number of palliative chemotherapy series. "
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