Dealing with the lack of evidence to treat depression in older patients with cancer: French Societies of Geriatric Oncology (SOFOG) and PsychoOncology (SFFPO) position paper based on a systematic review

Suicide risk and mortality among patients with cancer

Despite substantial progress in cancer therapy in recent decades, patients with cancer remain at high suicide risk. Data from individual studies have not been comprehensively quantified and specific risk factors are ill-defined. We assessed suicide mortality risk according to cancer prognosis, stage, time since diagnosis, gender, ethnicity, marital status, year of recruitment and geographic region. We searched EMBASE, MEDLINE, PsycINFO, Web of Science, CINAHL and Google Scholar for relevant articles up to February 2021. We used a random effects model, performed meta-regression meta-analysis and assessed heterogeneity and publication bias using I², funnel plots and Egger's and Begg's tests. We performed a systematic review including 62 studies and 46,952,813 patients. To avoid patient sample overlap, the meta-analysis was performed on 28 studies, involving 22,407,690 patients with cancer. Suicide mortality was significantly increased compared with the general population (standardized mortality ratio = 1.85, 95% confidence interval = 1.55-2.20). Risk was strongly related to cancer prognosis, cancer stage, time since diagnosis and geographic region. Patients with cancer, particularly those with specific risk factors, should be closely monitored for suicidality and need specialized care to reduce short- and long-term risks of suicide.

Supportive care practice: do we need guidelines?

PURPOSE OF REVIEW

To review the role of evidence-based clinical practice guidelines in promoting the quality and consistency of supportive care in oncology to meet the needs of practitioners and patients.

RECENT FINDINGS

To maintain quality, guidelines must be regularly updated in terms of content as new treatment modalities like immunotherapy are introduced, adapted to new methodologies such as the application of artificial intelligence, adoption of multiple symptoms or orphan symptoms and capture new endpoints such a patient-reported outcomes. This helps prevent a major barrier to implementation; negative attitudes of practitioners towards guidelines. Digital guidelines provide greater opportunities for dissemination, ease of updating and can be linked to education modules. The quality must be assured by critically appraising the literature and then grading the level of evidence of the guidelines. The benefits of supportive care guidelines include guidance for clinical decision-making in a changing field, continuing professional development of practitioners, a source of information for patients and in highlighting the gaps where further research is necessary.

SUMMARY

The implications are that guidelines are required for supportive care in cancer but they must be constantly updated and evolve in their structure, the rigour of appraisal and content to promote quality care.