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Yu H, Tao S, She W, Liu M, Wu Y, Lyu J. Analysis of suicide risk in adult US patients with squamous cell carcinoma: a retrospective study based on the Surveillance, Epidemiology and End Results database. BMJ Open 2022; 12:e061913. [PMID: 36109023 PMCID: PMC9478846 DOI: 10.1136/bmjopen-2022-061913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine the risk factors for suicide in patients with squamous cell carcinoma (SCC) in the USA. SETTING Patients with SCC diagnosed between 1975 and 2017 from the Surveillance, Epidemiology and End Results (SEER) database were selected for this study. PARTICIPANTS This study included patients with SCC older than 20 years who were diagnosed between 1975 and 2017. PRIMARY AND SECONDARY OUTCOME MEASURES The general population included in data from the US Centers for Disease Control and Prevention were used to calculate the suicide rate and standardised mortality rate (SMR) of SCC patients. Univariate and multivariate Cox regression analyses were used to identify risk factors for suicide in patients with SCC. RESULTS There were 415 268 SCC patients registered in the SEER database, among which 1157 cases of suicide were found, comprising a total of 2 289 772 person-years. The suicide rate for patients with SCC was 50.53 per 100 000 person-years, and the SMR was 4.13 (95% CI 3.90 to 4.38). The Cox regression analyses showed that the factors related to a high risk of suicide among patients with SCC included being male (vs female: HR 5.36, 95% CI 4.51 to 6.38, p<0.001), older at the diagnosis (70-79 vs ≤39 years: HR 1.46, 95% CI 1.09 to 2.08, p=0.012; ≥80 vs ≤39 years: HR 1.48, 95% CI 1.05 to 2.08, p=0.025) and white (vs black, HR 2.97, 95% CI 2.20 to 4.02, p<0.001) and surgery (vs not performed: HR 0.65, 95% CI 0.57 to 0.74, p<0.001). CONCLUSIONS Compared with the general population, patients with SCC in the USA have a higher risk of suicide. Being male, older at the diagnosis, white and having a higher histological grade are risk factors for suicide in patients.
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Affiliation(s)
- Haohui Yu
- Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Shengru Tao
- Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Wenli She
- Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Min Liu
- Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Yayun Wu
- Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Jun Lyu
- Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
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2
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Heinrich M, Hofmann L, Baurecht H, Kreuzer PM, Knüttel H, Leitzmann MF, Seliger C. Suicide risk and mortality among patients with cancer. Nat Med 2022; 28:852-859. [PMID: 35347279 DOI: 10.1038/s41591-022-01745-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/14/2022] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- Michael Heinrich
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Luisa Hofmann
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Hansjörg Baurecht
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Peter M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, Regensburg, Germany
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Corinna Seliger
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
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3
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Gentile G, Tambuzzi S, Calati R, Zoja R. A Descriptive Cohort of Suicidal Cancer Patients: Analysis of the Autopsy Case Series from 1993 to 2019 in Milan (Italy). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020829. [PMID: 35055655 PMCID: PMC8776118 DOI: 10.3390/ijerph19020829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/10/2022]
Abstract
Suicide in cancer patients has always been a subject of clinical studies, but the contribution of forensic pathology to this phenomenon is poorly reported. With the aim of at least partially filling this gap in information, at the Institute of Forensic Medicine of Milan, Italy, we assessed all suicides that occurred in cancer patients. A descriptive and retrospective analysis was carried out by examining the database of the Institute and autopsy reports. We included 288 suicide cases with proven cancer diseases. For each suicide, sex, age, country of origin, body area affected by cancer, further pathological history, medications, previous suicide attempts and suicidal communications, as well as the place where the suicide occurred, were assessed. Furthermore, from a forensic point of view, we considered the chosen suicide method and any involved means. The majority of cases were male older adults affected by lung, colon and prostate cancer. Violent suicide methods were prevalent, and the most represented suicide method was falling from height regardless of the body area affected by cancer. Such data may be of clinical use for clinicians engaged in the front lines in order to address suicide risk prevention strategies among cancer patients.
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Affiliation(s)
- Guendalina Gentile
- Department of Biomedical Sciences for Health, Section of Legal Medicine and Insurance, University of Milan, 20133 Milan, Italy; (G.G.); (S.T.); (R.Z.)
| | - Stefano Tambuzzi
- Department of Biomedical Sciences for Health, Section of Legal Medicine and Insurance, University of Milan, 20133 Milan, Italy; (G.G.); (S.T.); (R.Z.)
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 30029 Nimes, France
- Correspondence:
| | - Riccardo Zoja
- Department of Biomedical Sciences for Health, Section of Legal Medicine and Insurance, University of Milan, 20133 Milan, Italy; (G.G.); (S.T.); (R.Z.)
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4
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Muzyka M, Tagliafico L, Serafini G, Baiardini I, Braido F, Nencioni A, Monacelli F. Neuropsychiatric Disorders and Frailty in Older Adults over the Spectrum of Cancer: A Narrative Review. Cancers (Basel) 2022; 14:258. [PMID: 35008421 PMCID: PMC8796027 DOI: 10.3390/cancers14010258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The interplay between different neuropsychiatric conditions, beyond dementia, in the presence of a diagnosis of cancer in older adults may mediate patients' fitness and cancer-related outcomes. Here, we aimed to investigate the presence of depression, sleep disturbances, anxiety, attitude, motivation, and support in older adults receiving a diagnosis of cancer and the dimension of frailty in order to understand the magnitude of the problem. METHODS This review provides an update of the state of the art based on references from searches of PubMed between 2000 and June 2021. RESULTS The evidence obtained underscored the tight association between frailty and unfavorable clinical outcomes in older adults with cancer. Given the intrinsic correlation of neuropsychiatric disorders with frailty in the realm of cancer survivorship, the evidence showed they might have a correlation with unfavorable clinical outcomes, late-life geriatric syndromes and higher degree of frailty. CONCLUSIONS The identification of common vulnerabilities among neuropsychiatric disorders, frailty, and cancer may hold promise to unmask similar shared pathways, potentially intercepting targeted new interventions over the spectrum of cancer with the delivery of better pathways of care for older adults with cancer.
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Affiliation(s)
- Mariya Muzyka
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Luca Tagliafico
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Gianluca Serafini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, 16132 Genoa, Italy
| | - Ilaria Baiardini
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
| | - Fulvio Braido
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Alessio Nencioni
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy; (M.M.); (L.T.); (G.S.); (I.B.); (F.B.); (A.N.)
- Department of Internal Medicine and Medical Specialties (DIMI), Section of Geriatrics, 16132 Genoa, Italy
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5
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Ross S, Agin-Liebes G, Lo S, Zeifman RJ, Ghazal L, Benville J, Franco Corso S, Bjerre Real C, Guss J, Bossis A, Mennenga SE. Acute and Sustained Reductions in Loss of Meaning and Suicidal Ideation Following Psilocybin-Assisted Psychotherapy for Psychiatric and Existential Distress in Life-Threatening Cancer. ACS Pharmacol Transl Sci 2021; 4:553-562. [PMID: 33860185 PMCID: PMC8033770 DOI: 10.1021/acsptsci.1c00020] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Indexed: 12/13/2022]
Abstract
People with advanced cancer are at heightened risk of desire for hastened death (DHD), suicidal ideation (SI), and completed suicide. Loss of Meaning (LoM), a component of demoralization, can be elevated by a cancer diagnosis and predicts DHD and SI in this population. We completed a randomized controlled trial in which psilocybin-assisted psychotherapy (PAP) produced rapid and sustained improvements in depression, demoralization, and hopelessness in people with cancer. Converging epidemiologic and clinical trial findings suggests a potential antisuicidal effect of this treatment. To probe our hypothesis that PAP relieves SI through its beneficial impacts on depression and demoralization (LoM in particular), we performed secondary analyses assessing within- and between-group differences with regard to LoM and an SI composite score. Among participants with elevated SI at baseline, PAP was associated with within-group reductions in SI that were apparent as early as 8 h and persisted for 6.5 months postdosing. PAP also produced large reductions in LoM from baseline that were apparent 2 weeks after treatment and remained significant and robust at the 6.5 month and 3.2 and 4.5 year follow-ups. Exploratory analyses support our hypothesis and suggest that PAP may be an effective antisuicidal intervention following a cancer diagnosis due to its positive impact on hopelessness and demoralization and its effects on meaning-making in particular. These preliminary results implicate psilocybin treatment as a potentially effective alternative to existing antidepressant medications in patients with cancer that are also suicidal, and warrant further investigation in participants with elevated levels of depression and suicidality.
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Affiliation(s)
- Stephen Ross
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States.,Bellevue Hospital Center, New York, New York, 10016, United States
| | - Gabrielle Agin-Liebes
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, San Francisco, California, 94110, United States.,Zuckerberg San Francisco General Hospital, San Francisco, California, 94110, United States
| | - Sharon Lo
- Pacific University College of Health Professions, Hillsboro, Oregon 97123-4218, United States
| | | | - Leila Ghazal
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States
| | - Julia Benville
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States
| | - Silvia Franco Corso
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute, New York, New York, 10032-3784, United States
| | - Christian Bjerre Real
- Memorial Sloan Kettering Cancer Center, New York, New York, 10065-6007, United States
| | - Jeffrey Guss
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States.,Bellevue Hospital Center, New York, New York, 10016, United States
| | - Anthony Bossis
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States.,Bellevue Hospital Center, New York, New York, 10016, United States
| | - Sarah E Mennenga
- NYU Langone Health Center for Psychedelic Medicine, 462 First Avenue, New York, New York, 10016, United States.,NYU Grossman School of Medicine Department of PsychiatryNew York, New York, 10016, United States
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6
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Yu H, Cai K, Huang Y, Lyu J. Risk factors associated with suicide among leukemia patients: A Surveillance, Epidemiology, and End Results analysis. Cancer Med 2020; 9:9006-9017. [PMID: 33022890 PMCID: PMC7724501 DOI: 10.1002/cam4.3502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 12/24/2022] Open
Abstract
Previous studies have found that the risk of suicide is higher in patients diagnosed with cancer than in the general population. We aimed to identify potential risk factors associated with suicide in leukemia patients by analyzing data obtained from the Surveillance, Epidemiology, and End Results (SEER) database. We screened the SEER database for leukemia patients added between 1975 and 2017, and calculated their suicide rate and standardized mortality rate (SMR) relative to the total United States population from 1981 to 2017 as a reference. Univariate and multivariate Cox regression analyses were used to determine the risk factors for suicide in leukemia patients. We collected 142,386 leukemia patients who had been added to the SEER database from 1975 to 2017, of whom 191 patients committed suicide over an observation period of 95,397 person‐years. The suicide rate of leukemia patients was 26.41 per 100,000 person‐years, and hence the SMR of the suicided leukemia patients was 2.16 (95% confidence interval [CI] = 1.85–2.47). The univariate and multivariate Cox regression analyses showed that a high risk of suicide was associated with male sex (vs. female: hazard ratio [HR] = 4.41, 95% CI = 2.93–6.63, p < 0.001), older age at diagnosis (60–69 years vs. ≤39 years: HR = 2.60, 95% CI = 1.60–4.23, p < 0.001; 70–79 years vs. ≤39 years: HR = 2.84, 95% CI = 1.72–4.68, p < 0.001; ≥80 years vs. ≤39 years: HR = 2.94, 95% CI = 1.65–5.21, p < 0.001), white race (vs. black: HR = 6.80, 95% CI = 1.69–27.40, p = 0.007), acute myeloid leukemia (vs. lymphocytic leukemia: HR = 1.59, 95% CI = 1.09–2.33, p = 0.016), unspecified and other specified leukemia (vs. lymphocytic leukemia: HR = 2.72, 95% CI = 1.55–4.75, p < 0.001), and living in a small city (vs. large city: HR = 2.10, 95% CI = 1.23–3.60, p = 0.007). Meanwhile, being a non‐Hispanic black (vs. Hispanic: HR = 0.06, 95% CI = 0.01–0.62, p = 0.019) was a protective factor for suicide. Male sex, older age at diagnosis, white race, and acute myeloid leukemia were risk factors for suicide in leukemia patients, while being a non‐Hispanic black was a protective factor. Medical workers should, therefore, provide targeted preventive measures to leukemia patients with a high risk of suicide.
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Affiliation(s)
- Haohui Yu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ke Cai
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yulin Huang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
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7
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Du L, Shi HY, Yu HR, Liu XM, Jin XH, Yan-Qian, Fu XL, Song YP, Cai JY, Chen HL. Incidence of suicide death in patients with cancer: A systematic review and meta-analysis. J Affect Disord 2020; 276:711-719. [PMID: 32794450 DOI: 10.1016/j.jad.2020.07.082] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/27/2020] [Accepted: 07/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Growing evidence indicated the higher risk of suicide in cancer survivors compared with general population. Our aim is to systematically quantify the extent of suicide death and identify risk factors associated with the incidence of suicide in cancer patients. METHODS We conducted a meta-analysis of relevant studies published in English or Chinese before May 20, 2020. Suicide rate and the number of suicide death were extracted. Our main outcome was suicide rate per 100,000 person-years with 95% CIs using random-effects model. RESULTS The pooled incidence of suicide death was 39.72 per 100,000 person-years (95%CI, 33.91-46.52, I 2= 99.6%, P <0 .001). The suicide rate for cancer patients was higher in men (57.78, 95%CI, 47.31-70.56) than in women (14.47, 95%CI, 11.27-18.57). For both sexes combined, esophagus cancer had the highest rate of suicide (87.71, 95%CI, 27.42-280.54). By sex, suicide rates ranked first in males and females were pancreas cancer (195.70, 95%CI, 129.55-295.61) and esophagus cancer (18.34, 95%CI, 5.92-56.84), respectively. The highest suicide rate was 61.02(95%CI, 53.66-69.40) in Asia, and Oceania (24.07, 95%CI, 20.78-27.88) had lowest suicide rate. Suicide rate had a downward trend by years after diagnosis, with the first six months after cancer diagnosis clearly standing out (89.33, 95%CI, 50.64-157.58). LIMITATIONS Included studies came from high-income countries and our results might not represent the suicide rate among cancer patients in low- and middle-income countries. CONCLUSIONS The incidence of suicide among cancer patients was high despite the declined trend recent years, which emphasized psychological health aspects of interventions and perfecting suicide prevention programs.
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Affiliation(s)
- Lin Du
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Hai-Yan Shi
- Department of Thoracic Oncology, The People's Hospital of Rugao, Nantong, Jiangsu, China
| | - Hai-Rong Yu
- Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xiao-Man Liu
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xiao-Hong Jin
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yan-Qian
- Department of Oncology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xue-Lei Fu
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Yi-Ping Song
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Ji-Yu Cai
- School of Medicine, Nantong University, Nantong, Jiangsu, China
| | - Hong-Lin Chen
- School of Public Health, Nantong University, 9 Seyuan Road, Nantong 226000, Jiangsu, China.
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Abstract
Cancer is one of the most common diseases and suicide is one of the causes of cancer patients' mortality. However, the suicide mortality rate in cancer patients has not been thoroughly investigated. The aim of this study was to perform a systematic review and a meta-analysis of suicide mortality risk in cancer patients. The authors systematically searched PubMed, Scopus, psycInfo, and Google Scholar databases using MESH keywords until July 2018; searching was limited to English. Random effects model was used for meta-analyzing the studies. Forest plot was calculated for the whole of the 22 studies and the subgroups. Publication bias was examined, and qualitative evaluation of the articles entered into the meta-analysis was also carried out. 22 studies were included in the meta-analysis. Pooled Standardized Mortality Ratio (SMR) for suicide mortality (SMR = 1.55; 95% and confidence interval (CI) CI = 1.37-1.74) in cancer patients were achieved. It has been shown (SMR = 1.67; 95% CI = 1.48-1.89 and p < 0.001) that cancer has increased suicidal rates in men and also in women (SMR = 1.34; 95% CI = 1.20-1.50 and p < 0.001). The following results were reported based on the subtypes of cancer; pooled SMR = 2.06; 95% CI = 1.32-3.23, and p < 0.001 in esophagus, stomach, pancreas and liver cancers; SMR = 1.57; 95% CI = 1.26-1.97, and p < 0.001 in colon and rectum cancers; SMR = 3.07; 95% CI = 2.20-4.28, and p < 0.001 in bronchus, trachea and lung cancers; SMR = 1.24; 95% CI = 1.03-1.48, and p = 0.020 in breast cancer; SMR = 1.71; 95% CI = 1.38-2.12, and p < 0.001 in prostate cancer. Overall, there is an evaluated suicide mortality rate in cancer patients. There was some evidence of publication bias. Our findings indicate that cancer increases the risk of suicide. Given the results and co-morbidities between suicide-induced cancer and other psychological disorders, the development of psychological interventions can be useful in reducing the risk of suicide in these patients.
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Ravaioli A, Crocetti E, Mancini S, Baldacchini F, Giuliani O, Vattiato R, Bucchi L, Falcini F. Suicide death among cancer patients: new data from northern Italy, systematic review of the last 22 years and meta-analysis. Eur J Cancer 2020; 125:104-113. [DOI: 10.1016/j.ejca.2019.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/13/2019] [Accepted: 08/15/2019] [Indexed: 10/25/2022]
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10
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Kawashima Y, Yonemoto N, Inagaki M, Inoue K, Kawanishi C, Yamada M. Interventions to prevent suicidal behavior and ideation for patients with cancer: A systematic review. Gen Hosp Psychiatry 2019; 60:98-110. [PMID: 31377631 DOI: 10.1016/j.genhosppsych.2019.07.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/05/2019] [Accepted: 07/03/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study aimed to summarize interventions for suicide prevention in patients with cancer and highlight any methodological issues. METHODS We searched PubMed, PsycINFO, CINAHL, and the Cochrane database from their inception until July 2018. Additionally, we manually searched the references of included studies and recent systematic reviews of psychotherapy, antidepressants, and collaborative care for cancer patients with depression. RESULTS Of the 1365 retrieved articles, 11 randomized controlled trials and 11 intervention studies met the inclusion criteria. These were categorized by type of intervention: psychotherapy, pharmacotherapy, integrated collaborative care, muscle relaxation and therapeutic walking, and cancer treatment. The trials showed little evidence to confirm the effects of suicide prevention strategies. Seven trials were designed to assess the efficacy of interventions treating depression. In all studies, suicidal behavior or ideation was reported as one of the secondary outcomes. Three trials did not report information about suicidal ideation, despite assessing depressive symptoms using scales that contained suicidal ideation items. Most trials demonstrated inadequate study quality. CONCLUSIONS Our review summarized interventions for suicide prevention in patients with cancer and revealed methodological issues. The findings highlighted a need to explore new treatment strategies that focus on unique suicide risk factors among patients with cancer.
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Affiliation(s)
- Yoshitaka Kawashima
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashimachi, Kodaira, Tokyo 187-8553, Japan; Clinical Psychology Course, Department of Psycho-Social Studies, School of Arts and Letters, Meiji University, 1-1, Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8301, Japan.
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashimachi, Kodaira, Tokyo 187-8553, Japan; Department of Biostatistics, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, 89-1, Enyacho, Izumo City, Shimane 693-8501, Japan.
| | - Keisuke Inoue
- Psychiatric Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
| | - Chiaki Kawanishi
- Department of Neuropsychiatry, Sapporo Medical University Graduate School of Medicine, S1 W17, Chuo-ku, Sapporo 060-8556, Japan
| | - Mitsuhiko Yamada
- Department of Neuropsychopharmacology, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashimachi, Kodaira, Tokyo 187-8553, Japan.
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Saad AM, Gad MM, Al-Husseini MJ, AlKhayat MA, Rachid A, Alfaar AS, Hamoda HM. Suicidal death within a year of a cancer diagnosis: A population-based study. Cancer 2019; 125:972-979. [PMID: 30613943 DOI: 10.1002/cncr.31876] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The suicide risk after a new cancer diagnosis remains a controversial issue. This study examines the suicide risk within the year after a cancer diagnosis. This is the largest study to assess recent trends in suicide risk after a cancer diagnosis. METHODS Data were obtained from the Surveillance, Epidemiology, and End Results Program. All patients diagnosed with cancer between 2000 and 2014 were selected. The event was defined as death due to suicide within the first year after a cancer diagnosis, and patients who experienced the event after their diagnosis were observed. The observed/expected (O/E) ratio was assessed as well as the excess risk per 10,000 person-years to determine the suicide risk change after the diagnosis in comparison with the general population. RESULTS A total of 4,671,989 patients with cancer were included; 1585 committed suicide within 1 year of their diagnosis. The risk of suicide increased significantly with an O/E ratio of 2.52 and with an excess risk of 2.51 per 10,000 person-years. When the risk of suicide was studied according to the cancer site, the highest increases in the O/E ratio came after diagnoses of pancreatic cancer (8.01) and lung cancer (6.05). The risk of suicide also increased significantly after a diagnosis of colorectal cancer with an O/E ratio of 2.08. However, the risk of suicidal death did not increase significantly after breast and prostate cancer diagnoses. CONCLUSIONS The risk of suicide increases significantly in the first year after a diagnosis of cancer in comparison with the general population, and this increase varies with the type and prognosis of cancer. Close observation and referral to mental health services, when indicated, are important for mitigating such risk.
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Affiliation(s)
- Anas M Saad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | | | | | - Ahmad Rachid
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmad Samir Alfaar
- Ophthalmology Department, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hesham M Hamoda
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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12
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Increasing suicide risk among cancer patients in Lithuania from 1993 to 2012: a cancer registry-based study. Eur J Cancer Prev 2018; 26 Joining forces for better cancer registration in Europe:S197-S203. [PMID: 28914692 DOI: 10.1097/cej.0000000000000375] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Abstract
Backround Many factors increase vulnerability to suicide in cancer patients. Uncontrolled pain and other physical symptoms, psychological distress, and existential suffering are related to suicide in oncology. There is a strong consensus that physicians and nurses are not adequately trained to manage the potential suicide patient. This paper offers suggestions for the early recognition of cancer patients at risk of suicide, for the planning of crisis intervention and a physician-patient communication strategy. Methods A review of the literature about suicide in cancer patients was carried out by MEDLINE and PSYLIT and peer contacts. Results Through a review of the literature and their clinical experience, the authors outline a number of vulnerability factors of suicide with the intention to help health professionals to face the dilemma of suicide in cancer patients. Clinical vignettes reveal how a patient may reject his/her suicidal intention if adequate pharmacological and psychosocial supports are offered. Other case reports of patients refusing cancer therapy show that suicide is a complex phenomenon touching ethical, sociological, medical and psychiatric issues. Conclusions Our findings support the hypothesis that improved patient-physician communication, to supply adequate psychological crisis intervention, respect for patient-centered care, familiarity with the tenets of palliative medicine alongside effective education in suicidology, and the routine use of teamwork may reduce the need of suicide in cancer patients and probably the need to hasten death.
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Affiliation(s)
- Antonio Filiberti
- Who Collaborating Center for Cancer Control and Pain Relief, National Cancer Institute, Milan, Italy
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14
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Samawi HH, Shaheen AA, Tang PA, Heng DYC, Cheung WY, Vickers MM. Risk and predictors of suicide in colorectal cancer patients: a Surveillance, Epidemiology, and End Results analysis. ACTA ACUST UNITED AC 2017; 24:e513-e517. [PMID: 29270060 DOI: 10.3747/co.24.3713] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background The risk of suicide is higher for patients with colorectal cancer (crc) than for the general population. Given known differences in morbidity and sites of recurrence, we sought to compare the predictors of suicide for patients with colon cancer and with rectal cancer. Methods Using the U.S. Surveillance, Epidemiology, and End Results database, adult patients with confirmed adenocarcinoma of the colon or rectum during 1973-2009 were identified. Parametric and nonparametric tests were used to assess selected variables, and Cox proportional hazards regression models were used to determine predictors of suicide. Results The database identified 187,996 patients with rectal cancer and 443,368 with colon cancer. Compared with the rectal cancer group, the colon cancer group was older (median age: 70 years vs. 67 years; p < 0.001) and included more women (51% vs. 43%, p < 0.001). Suicide rates were similar in the colon and rectal cancer groups [611 (0.14%) vs. 337 (0.18%), p < 0.001]. On univariate analysis, rectal cancer was a predictor of suicide [hazard ratio (hr): 1.26; 95% confidence interval (ci): 1.10 to 1.43]. However, after adjusting for clinical and pathology factors, rectal cancer was not a predictor of suicide (hr: 1.05; 95% ci: 0.83 to 1.33). In the colon cancer cohort, independent predictors of suicide included older age, male sex, white race, and lack of primary resection. The aforementioned predictors, plus metastatic disease, similarly predicted suicide in the rectal cancer cohort. Conclusions The suicide risk in crc patients is low (<0.2%), and no difference was found based on location of the primary tumour. Sex, age, race, distant spread of disease, and intact primary tumour were the main predictors of suicide among crc patients. Further studies and interventions are needed to target these high-risk groups.
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Affiliation(s)
| | - A A Shaheen
- Department of Medicine, University of Calgary, Calgary, AB
| | - P A Tang
- Tom Baker Cancer Centre, Calgary, AB
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15
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Choi J, Lee M, Ki M, Lee JY, Song YJ, Kim M, Lee S, Park S, Lim J. Risk factors for feelings of sadness and suicide attempts among cancer survivors in South Korea: findings from nationwide cross-sectional study (KNHANES IV-VI). BMJ Open 2017; 7:e016130. [PMID: 29247081 PMCID: PMC5735398 DOI: 10.1136/bmjopen-2017-016130] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION As the number of cancer survivors is rapidly increasing with the increased incidence of the disease and improved survival of patients, the prevalence of, and risk factors for, mental health problems and suicidality among cancer survivors should be examined. METHODS AND ANALYSIS Using data obtained from the Korean National Health and Nutrition Examination Survey (2007-2013), we examined 1285 and 33 772 participants who had been and never been diagnosed with cancer, respectively. We investigated the risks of feelings of sadness and suicide attempts among cancer survivors and general population and examined differences in the risks of cancer survivors among subgroups according to cancer-related characteristics. RESULTS The median age of survivors at the time of the survey and at diagnosis was 63 and 54 years, respectively. After adjusting for sex, level of education, household income, occupation, marital status, cancer type, current status of treatment, age at diagnosis and years since diagnosis, the risk of suicide attempts was significantly higher in participants diagnosed with cancer before 45 years of age compared with those diagnosed at 45-64 years (adjusted OR=3.81, 95% CI 1.07 to 13.60, P=0.039), and the higher risk of suicide attempts with borderline significance was found in those for whom more than 10 years had passed since diagnosis compared with those for whom the diagnosis was made only 2-10 years ago (adjusted OR=3.38, 95% CI 0.98 to 11.70, P=0.055). However, feelings of sadness were not significantly associated with any cancer-related characteristic. CONCLUSION Our results reveal an increased risk of suicide attempts among cancer survivors diagnosed early in life and in those for whom more than 10 years has passed since the diagnosis, suggesting the need for intensive monitoring and support for mental health problems and suicidal risks in this population.
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Affiliation(s)
- Jeewoong Choi
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Mijo Lee
- Department of Radiation Oncology, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Myung Ki
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Ju-Yeong Lee
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Yeong-Jun Song
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Miram Kim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Sunyoung Lee
- Department of Radiation Oncology, Sun Medical Cancer Center, Daejeon, The Republic of Korea
| | - Soonjoo Park
- Department of Nursing, Eulji University College of Medicine, Daejeon, The Republic of Korea
| | - Jiseun Lim
- Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, The Republic of Korea
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Tiernan E, Casey P, O'Boyle C, Birkbeck G, Mangan M, O'Siorain L, Kearney M. Relations between Desire for Early Death, Depressive Symptoms and Antidepressant Prescribing in Terminally Ill Patients with Cancer. J R Soc Med 2017; 95:386-90. [PMID: 12151487 PMCID: PMC1279962 DOI: 10.1177/014107680209500803] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Some patients with advanced cancer express the wish for an early death. This may be associated with depression. We examined the relations between depressive symptoms and desire for early death (natural or by euthanasia or physician-assisted suicide) in 142 terminally ill patients with cancer being cared for by a specialist palliative care team. They completed the Hospital Anxiety and Depression Scale questionnaire and answered four supplementary questions on desire for early death. Only 2 patients expressed a strong wish for death by some form of suicide or euthanasia. 120 denied that they ever wished for early release. The desire for early death correlated with depression scores. Depressive symptoms were common in the whole group but few were on antidepressant therapy. Better recognition and treatment of depression might improve the lives of people with terminal illness and so lessen desire for early death, whether natural or by suicide.
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Affiliation(s)
- E Tiernan
- Our Lady's Hospice, Harold's Cross, Dublin 6W, Ireland.
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Jayakrishnan TT, Sekigami Y, Rajeev R, Gamblin TC, Turaga KK. Morbidity of curative cancer surgery and suicide risk. Psychooncology 2016; 26:1792-1798. [PMID: 27421798 DOI: 10.1002/pon.4221] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 06/07/2016] [Accepted: 07/10/2016] [Indexed: 11/08/2022]
Abstract
IMPORTANCE Curative cancer operations lead to debility and loss of autonomy in a population vulnerable to suicide death. The extent to which operative intervention impacts suicide risk is not well studied. OBJECTIVE To examine the effects of morbidity of curative cancer surgeries and prognosis of disease on the risk of suicide in patients with solid tumors. DESIGN Retrospective cohort study using Surveillance, Epidemiology, and End Results data from 2004 to 2011; multilevel systematic review. SETTING General US population. PARTICIPANTS Participants were 482 781 patients diagnosed with malignant neoplasm between 2004 and 2011 who underwent curative cancer surgeries. MAIN OUTCOMES AND MEASURES Death by suicide or self-inflicted injury. RESULTS Among 482 781 patients that underwent curative cancer surgery, 231 committed suicide (16.58/100 000 person-years [95% confidence interval, CI, 14.54-18.82]). Factors significantly associated with suicide risk included male sex (incidence rate [IR], 27.62; 95% CI, 23.82-31.86) and age >65 years (IR, 22.54; 95% CI, 18.84-26.76). When stratified by 30-day overall postoperative morbidity, a significantly higher incidence of suicide was found for high-morbidity surgeries (IR, 33.30; 95% CI, 26.50-41.33) vs moderate morbidity (IR, 24.27; 95% CI, 18.92-30.69) and low morbidity (IR, 9.81; 95% CI, 7.90-12.04). Unit increase in morbidity was significantly associated with death by suicide (odds ratio, 1.01; 95% CI, 1.00-1.03; P = .02) and decreased suicide-specific survival (hazards ratio, 1.02; 95% CI, 1.00-1.03, P = .01) in prognosis-adjusted models. CONCLUSIONS In this sample of cancer patients in the Surveillance, Epidemiology, and End Results database, patients that undergo high-morbidity surgeries appear most vulnerable to death by suicide. The identification of this high-risk cohort should motivate health care providers and particularly surgeons to adopt screening measures during the postoperative follow-up period for these patients.
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Affiliation(s)
- Thejus T Jayakrishnan
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yurie Sekigami
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rahul Rajeev
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kiran K Turaga
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Park S, Hong JP, Lee JK, Park YM, Park Y, Jeon J, Ahn MH, Yoon SC. Associations between the neuron-specific glucocorticoid receptor (NR3C1) Bcl-1 polymorphisms and suicide in cancer patients within the first year of diagnosis. Behav Brain Funct 2016; 12:22. [PMID: 27401254 PMCID: PMC4940702 DOI: 10.1186/s12993-016-0104-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/15/2016] [Indexed: 11/21/2022] Open
Abstract
Background Cancer diagnosis is associated with an increased suicide risk, particularly within the first 1 year after diagnosis of cancer. Abnormal function of the hypothalamic–pituitary–adrenal axis has been implicated in the pathophysiology of depression and suicide. We examined genetic associations of the functional Bcl-1 polymorphism of (rs41423247) neuron-specific glucocorticoid receptor (NR3C1) gene, with death by suicide in cancer patients. Suicides occurring within a year of cancer diagnosis (‘early suicide’) were considered separately from those suicides during the second or subsequent year (‘late suicide’) after cancer diagnosis. Methods The subjects consisted of 343 cancer patients admitted to a general hospital in Seoul, South Korea from 1996 to 2009, of which 182 had died by suicide and 161 were alive on December 31, 2009. Genomic DNA was extracted from formalin-fixed paraffin-embedded tissue sample of patients with cancer. We conducted a case-control association analysis of Bcl-1 polymorphism of NR3C1 gene. Results Subjects carrying the GG genotype of Bcl-1 polymorphism were at increased risk of early suicide when compared to those carrying the CC genotype (OR 3.80, 95 % CI 1.02–14.16, p = .047). Similarly, those individuals carrying the GG genotype (recessive mode) had an increased risk of early suicide relative to the CC or CG genotype (OR 3.71, 95 % CI 1.03–13.43, p = .045). However, there were no differences in the genotype distributions of the NR3C1 Bcl-1 polymorphism between late suicide cases and controls. Conclusions Our findings suggest that the NR3C1 Bcl-1 polymorphisms may be involved in the susceptibility to suicide within the first year after cancer diagnosis among cancer patients in Korean population.
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Affiliation(s)
- Subin Park
- Research Planning Division, Mental Health Research Institute, National Center for Mental Health, Seoul, Republic of Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Jong-Keuk Lee
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Mi Park
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yangsoon Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Juri Jeon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Myeong Hee Ahn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se Chang Yoon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 135-710, Republic of Korea.
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Sugawara A, Kunieda E. Suicide in patients with gastric cancer: a population-based study. Jpn J Clin Oncol 2016; 46:850-5. [PMID: 27307574 DOI: 10.1093/jjco/hyw075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 05/19/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We conducted this study to examine the rate of suicide in patients with gastric cancer and to identify factors associated with increased risk of suicide using the Surveillance, Epidemiology, and End Results database. METHODS The database was queried for patients who were diagnosed with gastric cancer from 1998 to 2011. The rate of suicide and standardized mortality ratio were calculated. Multivariable analyses were conducted to identify factors associated with increased risk of suicide. RESULTS A total of 65 535 patients with 109 597 person-years of follow-up were included. A total of 68 patients died of suicide. The age-adjusted rate of suicide was 34.6 per 100 000 person-years (standardized mortality ratios, 4.07; 95% confidence interval, 3.18-5.13). The rate of suicide was highest within the first 3 months after cancer diagnosis (standardized mortality ratios, 67.67; 95% confidence interval, 40.74-106.15). Results of multivariable analyses showed that male sex (incidence rate ratio, 7.15; 95% confidence interval, 3.05-16.78; P < 0.0001), White race (incidence rate ratio, 3.23; 95% confidence interval, 1.00-10.35; P = 0.0491), unmarried status (incidence rate ratio, 2.01; 95% confidence interval, 1.22-3.30; P = 0.0060) and distant stage disease (incidence rate ratio, 2.90; 95% confidence interval, 1.72-4.92; P < 0.0001) were significantly associated with increased risk of suicide. CONCLUSIONS Patients with gastric cancer have an ~4-fold higher risk of suicide compared with the general US population. The suicide risk is highest within the first 3 months after diagnosis. Male sex, White race, unmarried status and distant stage disease are significantly associated with increased risk of suicide.
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Affiliation(s)
- Akitomo Sugawara
- Department of Radiation Oncology, Tokai University Hachioji Hospital, Hachioji
| | - Etsuo Kunieda
- Department of Radiation Oncology, Tokai University School of Medicine, Isehara, Japan
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Fässberg MM, Cheung G, Canetto SS, Erlangsen A, Lapierre S, Lindner R, Draper B, Gallo JJ, Wong C, Wu J, Duberstein P, Wærn M. A systematic review of physical illness, functional disability, and suicidal behaviour among older adults. Aging Ment Health 2016; 20:166-94. [PMID: 26381843 PMCID: PMC4720055 DOI: 10.1080/13607863.2015.1083945] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To conduct a systematic review of studies that examined associations between physical illness/functional disability and suicidal behaviour (including ideation, nonfatal and fatal suicidal behaviour) among individuals aged 65 and older. METHOD Articles published through November 2014 were identified through electronic searches using the ERIC, Google Scholar, PsycINFO, PubMed, and Scopus databases. Search terms used were suicid* or death wishes or deliberate self-harm. Studies about suicidal behaviour in individuals aged 65 and older with physical illness/functional disabilities were included in the review. RESULTS Sixty-five articles (across 61 independent samples) met inclusion criteria. Results from 59 quantitative studies conducted in four continents suggest that suicidal behaviour is associated with functional disability and numerous specific conditions including malignant diseases, neurological disorders, pain, COPD, liver disease, male genital disorders, and arthritis/arthrosis. Six qualitative studies from three continents contextualized these findings, providing insights into the subjective experiences of suicidal individuals. Implications for interventions and future research are discussed. CONCLUSION Functional disability, as well as a number of specific physical illnesses, was shown to be associated with suicidal behaviour in older adults. We need to learn more about what at-risk, physically ill patients want, and need, to inform prevention efforts for older adults.
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Affiliation(s)
| | - Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | | | - Annette Erlangsen
- Research Unit, Mental Health Centre Copenhagen, Denmark,Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sylvie Lapierre
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Reinhard Lindner
- Geriatric Psychosomatics and Psychotherapy, Medical Geriatric Clinic Albertinen-Haus, University of Hamburg, Hamburg, Germany
| | - Brian Draper
- School of Psychiatry, University of NSW, Sydney, Australia
| | - Joseph J. Gallo
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jing Wu
- Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
| | - Paul Duberstein
- Department of Psychiatry and Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Margda Wærn
- Section of Psychiatry and Neurochemistry, University of Gothenburg/Sahlgrenska University Hospital, Gothenburg, Sweden,Corresponding author.
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Castelpietra G, Gobbato M, Valent F, Bovenzi M, Barbone F, Clagnan E, Pascolo-Fabrici E, Balestrieri M, Isacsson G. Somatic disorders and antidepressant use in suicides: A population-based study from the Friuli Venezia Giulia region, Italy, 2003-2013. J Psychosom Res 2015; 79:372-7. [PMID: 26526311 DOI: 10.1016/j.jpsychores.2015.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many somatic disorders are complicated by depression and increase the risk of suicide. Little is known about whether antidepressants might reduce the suicidal risk in patients with somatic disorders. METHODS Data on diagnoses and antidepressant prescriptions were derived from the Social and Health Information System of the Friuli Venezia Giulia Region. Cases were all suicides that occurred in the region during the years 2003-2013 and were sex- and age-matched to controls from the general population. Conditional logistic regression analysis was used to assess the association between suicide and somatic disorders. RESULTS The suicide rate in Friuli Venezia Giulia decreased from 11.3 to 10.7 per 100,000 inhabitants during the years 2003-2013, however patients with somatic disorder had a three times increased risk of suicide. Elderly somatic patients' suicide risk was twice as high as younger patients. The risk increased from 2.6 to 9.8 times as the number of comorbid disorders increased from 1 to 4 and over. Although no significant risk of suicide in patients with somatic disorders was found when patients were adherent to antidepressants, only 11.5% of the suicides was adherent in the year prior to death. CONCLUSIONS Medical illnesses and underlying depressive symptoms may have a synergy effect on the risk of suicide, particularly in older patients and in patients with multiple morbidities. Since medically ill subjects adherent to antidepressants did not show a significant risk of suicide, early identification and adequate treatment of depression in somatic patients should be considered in order to prevent suicide.
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Affiliation(s)
- Giulio Castelpietra
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Central Health Directorate/Classification Area, Friuli Venezia Giulia Region, Italian Collaborating Centre for the WHO Family of International Classifications, Udine, Italy.
| | - Michele Gobbato
- Epidemiological Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
| | - Francesca Valent
- Epidemiological Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
| | - Massimo Bovenzi
- Department of Medical Sciences, University of Trieste, Trieste, Italy.
| | - Fabio Barbone
- Department of Medical Sciences, University of Trieste, Trieste, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Elena Clagnan
- Epidemiological Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
| | | | - Matteo Balestrieri
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
| | - Göran Isacsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
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Ahn MH, Park S, Lee HB, Ramsey CM, Na R, Kim SO, Kim JE, Yoon S, Hong JP. Suicide in cancer patients within the first year of diagnosis. Psychooncology 2014; 24:601-7. [DOI: 10.1002/pon.3705] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 07/19/2014] [Accepted: 09/16/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Myung Hee Ahn
- Department of Psychiatry, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Subin Park
- Department of Psychiatry; Seoul National Hospital; Seoul Korea
| | | | | | - Riji Na
- Department of Psychiatry, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Seon Ok Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Shinkyo Yoon
- Department of Oncology, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Asan Medical Center; Ulsan University College of Medicine; Seoul Korea
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de la Grandmaison GL, Watier L, Cavard S, Charlier P. Are suicide rates higher in the cancer population? An investigation using forensic autopsy data. Med Hypotheses 2014; 82:16-9. [DOI: 10.1016/j.mehy.2013.10.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 10/22/2013] [Accepted: 10/28/2013] [Indexed: 10/26/2022]
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Lu D, Fall K, Sparén P, Ye W, Adami HO, Valdimarsdóttir U, Fang F. Suicide and suicide attempt after a cancer diagnosis among young individuals. Ann Oncol 2013; 24:3112-7. [PMID: 24169626 DOI: 10.1093/annonc/mdt415] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Data are scarce on the potential change in suicidal behavior among adolescents and young adults after receiving a cancer diagnosis. PATIENTS AND METHODS We conducted a population-based cohort study including 7 860 629 Swedes at the age of ≥15 during 1987-2009. Among the cohort participants, 12 669 received a first diagnosis of primary cancer between the age of 15 and 30. We measured the relative risks (RRs) of suicidal behavior (defined as completed suicides or suicide attempts) after cancer diagnosis. We also carried out a case-crossover study nested within the cohort to adjust for unmeasured confounders. RESULTS Twenty-two completed suicides (versus 14 expected) and 136 suicide attempts (versus 80 expected) were identified among the cancer patients. The RR of suicidal behavior was 1.6 [95% confidence interval (CI), 1.4-1.9] after a cancer diagnosis, compared with cancer-free individuals. Risk increase was greatest immediately after diagnosis; the RR was 2.5 (95% CI 1.7-3.5) during the first year after diagnosis and was 1.5 (95% CI 1.2-1.8) thereafter. This pattern was similar for completed suicide and suicide attempts. The elevated risks were evident for majority of the main cancer types, except for cancer in thyroid, testis and melanoma. The case-crossover analysis of suicidal behavior during the first year after cancer diagnosis revealed similar results. CONCLUSIONS Adolescents and young adults receiving a cancer diagnosis are at substantially increased risk of suicidal behavior, particularly during the first year after diagnosis. Although the absolute excess risk is modest, these findings emphasize the need to support and carefully monitor this vulnerable population.
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Affiliation(s)
- D Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
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Suicides among cancer patients in Lithuania: A population-based census-linked study. Cancer Epidemiol 2013; 37:714-8. [DOI: 10.1016/j.canep.2013.05.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/27/2013] [Accepted: 05/29/2013] [Indexed: 11/24/2022]
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Ward KK, Roncancio AM, Plaxe SC. Women with gynecologic malignancies have a greater incidence of suicide than women with other cancer types. Suicide Life Threat Behav 2013; 43:109-15. [PMID: 23278597 PMCID: PMC3955113 DOI: 10.1111/sltb.12002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 09/07/2012] [Indexed: 11/26/2022]
Abstract
To evaluate risk of suicide of women with invasive gynecologic malignancies, the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (1973-2007) was queried. Suicide per 100,000 women with gynecologic malignancies was compared with that of women with other malignancies; suicide was 30% more likely in those with gynecologic malignancies. Most suicides occurred within 4 years of diagnosis. Better understanding of the descriptive epidemiology of suicide among women with gynecologic malignancies could lead to improved risk assessment, screening, and prevention of this potentially avoidable cause of death.
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Affiliation(s)
- Kristy K. Ward
- Rebecca and John Moores UCSD Cancer Center Department of Reproductive Medicine, Division of Gynecologic Oncology La Jolla, CA
| | - Angelica M. Roncancio
- The University of Texas School of Public Health Center for Heath Promotion and Prevention Research Houston, TX
| | - Steven C. Plaxe
- Rebecca and John Moores UCSD Cancer Center Department of Reproductive Medicine, Division of Gynecologic Oncology La Jolla, CA
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Kendal WS, Kendal WM. Comparative Risk Factors for Accidental and Suicidal Death in Cancer Patients. CRISIS 2012; 33:325-34. [DOI: 10.1027/0227-5910/a000149] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Wayne S. Kendal
- Division of Radiation Oncology, The Ottawa Hospital Cancer Centre, The University of Ottawa, Canada
- The Ottawa Hospital Research Institute, Canada
| | - Wendy M. Kendal
- Department of Family and Community Medicine, St. Paul’s Hospital, Vancouver, Canada
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Macleod S. Assisted dying in liberalised jurisdictions and the role of psychiatry: a clinician's view. Aust N Z J Psychiatry 2012; 46:936-45. [PMID: 23028195 DOI: 10.1177/0004867411434714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Assisted dying is a contentious and topical issue. Mental disorder is a relevant influence on requests of hastened death. The psychiatry of dying is not a prominent component in the assessment of euthanasia and physician-assisted suicide (PAS) in jurisdictions with liberalised assisted dying laws. The literature on the assessment processes, with particular reference to mental status, involved in euthanasia requests is considered. METHODS An experienced palliative medicine specialist and psychiatrist selectively reviewed the recent literature published about the mental health issues involved in euthanasia and PAS. RESULTS Assessments of competency, sustained wish to die prematurely, depressive disorder, demoralisation and 'unbearable suffering' in the terminally ill are clinically uncertain and difficult tasks. There is a growing psychiatric and psychological literature on the mental status of the terminally ill. As yet psychiatry does not have the expertise to 'select' those whose wish for hastened death is rational, humane and 'healthy'. Rarely in those societies with liberalised assisted dying laws are psychiatrists involved in the decision-making for individuals requesting early death. This role is fulfilled by non-specialists. CONCLUSIONS There remain significant concerns about the accuracy of psychiatric assessment in the terminally ill. Mental processes are more relevant influences on a hastened wish to die than are the physical symptoms of terminal malignant disease. Psychiatric review of persons requesting euthanasia is relevant. It is not obligatory or emphasised in those legislations allowing assisted dying. Psychiatry needs to play a greater role in the assessment processes of euthanasia and PAS.
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Affiliation(s)
- Sandy Macleod
- Health Sciences Centre, University of Canterbury, Christchurch, New Zealand.
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Rozovski U, Arad R, Ben-Tal O, Shahar T, Naparstek E. Suicide after hematopoietic SCT: the story of AG. Bone Marrow Transplant 2012; 48:301-2. [PMID: 22773128 DOI: 10.1038/bmt.2012.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Güth U, Myrick ME, Reisch T, Bosshard G, Schmid SM. Suicide in breast cancer patients: an individual-centered approach provides insight beyond epidemiology. Acta Oncol 2011; 50:1037-44. [PMID: 21861596 DOI: 10.3109/0284186x.2011.602112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Epidemiologic studies have identified increased suicide rates among breast cancer (BC) patients. The population-based approach, however, has considerable methodic shortcomings. None of the studies have been carried out in a prospective manner and none reported suicide rates from a country in which physician-assisted suicide (PAS) is legal. PATIENTS AND METHODS All cases recorded by a prospective Swiss BC database during a 17-year period (1990-2006; n = 1165) were analyzed. Using an individual-centered approach, the cases of women who committed suicide are reported according to the psychological autopsy method. RESULTS In six patients (0.5%; 5.1/1.000 patients), suicidal death was identified. In four patients, suicide was committed during late stages of metastatic BC. In two cases, comorbid conditions were associated with suicide. Three women chose PAS. CONCLUSION The individual-centered approach is a well-suited innovative concept to increase the knowledge regarding the relationship between cancer and suicide. We found a two to seven times higher suicide rate than those reported in epidemiologic studies. The population-based approach can barely elucidate the immense variety of one of the most personal decisions: the act of intentionally ending one's own life. These studies suffer from systematic failure of analysis since they did not a) consider the potential confounding role of comorbid medical and/or psychiatric conditions, and b) report in which disease stage suicide was committed, since the decisive disease-related event whether and when metastatic disease occurred was not recorded. Furthermore, epidemiologic data stems from countries in which PAS is prohibited and therefore not included in official statistics. This grey area of medicine accounts for a greater scope of underreporting than had previously been assumed.
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Affiliation(s)
- Uwe Güth
- University Hospital Basel, Department of Gynecology and Obstetrics, Switzerland.
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Spoletini I, Gianni W, Caltagirone C, Madaio R, Repetto L, Spalletta G. Suicide and cancer: Where do we go from here? Crit Rev Oncol Hematol 2011; 78:206-19. [DOI: 10.1016/j.critrevonc.2010.05.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 04/26/2010] [Accepted: 05/07/2010] [Indexed: 12/21/2022] Open
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Robson A, Scrutton F, Wilkinson L, MacLeod F. The risk of suicide in cancer patients: a review of the literature. Psychooncology 2011; 19:1250-8. [PMID: 20213857 DOI: 10.1002/pon.1717] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This review investigates the risk of suicide in people diagnosed with cancer. METHOD A literature search of PsycINFO, MEDLINE, EMBASE and CINAHL yielded 677 articles of which the abstracts were reviewed for their relevance. Seventy-one articles were identified as relevant and a further 3 were identified in a search of cited and citing articles; following application of inclusion and exclusion criteria, 39 articles were included in the review. RESULTS The reported incidence of completed suicide in cancer patients ranged from standardised mortality ratio of 1 to 11. The reported percentages of suicidal ideation in non-psychiatric populations of cancer patients ranged from 0.8 to 71.4%, compared to a reported prevalence of suicidal ideation in the general population, of between 1.1 and 19.8%. Risk factors identified for completed suicide and suicidal ideation in cancer patients include mental health, socio-demographic and illness factors. Some of these risk factors extend to the general population; however, some are specific to cancer such as cancer site, physical functioning and prognosis. CONCLUSIONS Despite the prevalence of suicidal ideation in a cancer population being comparable to the general population, the prevalence of completed suicide is elevated. Although suicidal ideation does not necessarily result in completed suicide, it is important that adequate training be provided for cancer professionals on the risk factors for suicide in cancer patients.
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Affiliation(s)
- Anna Robson
- Department of Psychological Services and Research, Nithbank, Dumfries, UK.
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Johnson TV, Garlow SJ, Brawley OW, Master VA. Peak window of suicides occurs within the first month of diagnosis: implications for clinical oncology. Psychooncology 2011; 21:351-6. [DOI: 10.1002/pon.1905] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 12/07/2010] [Accepted: 12/11/2010] [Indexed: 11/08/2022]
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Turaga KK, Malafa MP, Jacobsen PB, Schell MJ, Sarr MG. Suicide in patients with pancreatic cancer. Cancer 2010; 117:642-7. [PMID: 20824626 DOI: 10.1002/cncr.25428] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2009] [Revised: 02/09/2010] [Accepted: 02/09/2010] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depression is highly prevalent in patients with pancreatic cancer and can result in fatal outcomes from suicides. The authors report suicide rates among patients with pancreatic cancer in the United States and identify factors associated with greater suicide rates. METHODS The current study reviewed data in the SEER database for patients diagnosed with pancreatic adenocarcinoma from 1995-2005. Logistic regression models were used to perform multivariate modeling for factors associated with suicide, while Kaplan-Meier analysis was used to assess factors affecting survival. RESULTS Among 36,221 patients followed for 22,145 person-years, the suicide rate was 135.4 per 100,000 person-years. The corresponding rate in the US population aged 65-74 years was 12.5 per 100,000 person-years, with a Standardized Mortality Ratio (SMR) of 10.8 (95% CI, 9.2-12.7). Greater suicide rates were noted in males (Odds Ratio (OR) 13.5 [95% CI, 3.2-56.9, P < .001]) and, among males, in patients undergoing an operative intervention (OR 2.5 [95% CI, 1.0-6.5, P = .05]). Married men had a lesser risk of committing suicide (OR 0.3 [95% CI, 0.1-0.6, P = .002]). Median survival among patients undergoing operative intervention was 2 months for those who committed suicide compared with 10 months for those who did not commit suicide. CONCLUSIONS Male patients with pancreatic adenocarcinoma have a risk of suicide nearly 11 times that of the general population. Patients who undergo an operative intervention are more likely to commit suicide, generally in the early postoperative period.
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Affiliation(s)
- Kiran K Turaga
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.
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Lin HC, Wu CH, Lee HC. Risk factors for suicide following hospital discharge among cancer patients. Psychooncology 2010; 18:1038-44. [PMID: 19156684 DOI: 10.1002/pon.1483] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aims to examine risk factors associated with 3-month post-discharge suicide among cancer patients using Taiwan's nationwide, population-based datasets. METHODS The study cohort comprised all cancer patients discharged from hospitals from 2002 to 2004, inclusive, who committed suicide within 90 days of discharge (n=311). The control group consisted of 1555 cancer patients who did not commit suicide within 90 days of discharge. The dependent variable was whether or not a patient committed suicide within 90 days of discharge, while the independent variables included patient, hospital and physician characteristics at index hospitalization. Cox proportional hazard regression was carried out to compute the 90-day survival rate, adjusting for possible confounding factors. RESULTS The mean interval from discharge to suicide was 39.7 days (+/-95.2) and almost half (46.3%) of the 3-month post-discharge suicides occurred within 14 days after discharge. The adjusted hazard of committing suicide for patients who were not hospitalized in the preceding year was 1.68 (p=0.009), 1.61 (p=0.033), and 2.51 (p<0.001) times greater, respectively, than patients who were hospitalized once, twice and more than twice within the year before index hospitalization. The hazard of committing suicide among patients who were unemployed was 1.71 (p<0.001) times that of their employed counterparts. CONCLUSIONS We conclude that, while our study was limited to suicides among cancer patients within 90 days of discharge, around 60% of deaths occurred within the first month after discharge. The relevant risk factors include the number of hospitalizations within 1 year and employment status.
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Affiliation(s)
- Herng-Ching Lin
- School of Health Care Administration, Taipei Medical University, Taipei 110, Taiwan
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Robinson D, Renshaw C, Okello C, Møller H, Davies EA. Suicide in cancer patients in South East England from 1996 to 2005: a population-based study. Br J Cancer 2009; 101:198-201. [PMID: 19471277 PMCID: PMC2713698 DOI: 10.1038/sj.bjc.6605110] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Studies from around the world have shown that suicide risk is increased in cancer patients, but no previous detailed analysis has been carried out in England. METHODS We calculated standardised mortality ratios (SMRs) for suicide in 206,129 men and 211,443 women diagnosed with cancer in South East England between 1996 and 2005, relative to suicide rates in the general population. RESULTS We found a significantly increased risk of suicide in men (SMR 1.45, 95% confidence interval (CI) 1.20-1.73) and a moderately increased risk in women (SMR 1.19, 95% CI 0.88-1.57). In both sexes, relative risk of suicide was greatest in the first year after cancer diagnosis (SMR for men 2.42, 95% CI 1.84-3.13; SMR for women 1.44, 95% CI 0.82-2.33), and was also greater in individuals diagnosed with types of cancer with high fatality (SMR for men 2.67, 95% CI 1.71-3.97; SMR for women 2.17, 95% CI 0.80-4.73). CONCLUSION There is a critical period immediately after the diagnosis of cancer during which the excess risk of suicide is particularly high. Carers need to be aware of the importance of attending to both the physical and emotional needs of cancer patients and cancer survivors.
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Affiliation(s)
- D Robinson
- Division of Cancer Studies, King's College London, Thames Cancer Registry, London, UK.
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Walker J, Waters RA, Murray G, Swanson H, Hibberd CJ, Rush RW, Storey DJ, Strong VA, Fallon MT, Wall LR, Sharpe M. Better Off Dead: Suicidal Thoughts in Cancer Patients. J Clin Oncol 2008; 26:4725-30. [DOI: 10.1200/jco.2007.11.8844] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Jane Walker
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Rachel A. Waters
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Gordon Murray
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Helen Swanson
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Carina J. Hibberd
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert W. Rush
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Dawn J. Storey
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Vanessa A. Strong
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Marie T. Fallon
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Lucy R. Wall
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Michael Sharpe
- From the University of Edinburgh Cancer Research Centre, School of Molecular and Clinical Medicine, University of Edinburgh; the Edinburgh National Health Service Cancer Centre, Edinburgh, Scotland; and the Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
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Misono S, Weiss NS, Fann JR, Redman M, Yueh B. Incidence of suicide in persons with cancer. J Clin Oncol 2008; 26:4731-8. [PMID: 18695257 DOI: 10.1200/jco.2007.13.8941] [Citation(s) in RCA: 402] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE The purpose of this study was to characterize suicide rates among patients with cancer in the United States and identify patient and disease characteristics associated with higher suicide rates. Prior studies, mostly in Europe, have suggested that patients with cancer may be at increased risk for suicide, but large cohort studies comparing patients with cancer with the general population have not been performed in the United States. METHODS Patients in the study were residents of geographic areas served by the Surveillance, Epidemiology, and End Results (SEER) program who were diagnosed with cancer from 1973 to 2002. Comparisons with the general US population were based on mortality data collected by the National Center for Health Statistics. This was a retrospective cohort study of suicide in persons with cancer. RESULTS Among 3,594,750 SEER registry patients observed for 18,604,308 person-years, 5,838 suicides were identified, for an age-, sex-, and race-adjusted rate of 31.4/100,000 person-years. In contrast, the suicide rate in the general US population was 16.7/100,000 person-years. Higher suicide rates were associated with male sex, white race, and older age at diagnosis. The highest suicide risks were observed in patients with cancers of the lung and bronchus (standardized mortality ratio [SMR] = 5.74; 95% CI, 5.30 to 6.22), stomach (SMR = 4.68; 95% CI, 3.81 to 5.70), oral cavity and pharynx (SMR = 3.66; 95% CI, 3.16 to 4.22), and larynx (SMR = 2.83; 95% CI, 2.31 to 3.44). SMRs were highest in the first 5 years after diagnosis with cancer. CONCLUSION Patients with cancer in the United States have nearly twice the incidence of suicide of the general population, and suicide rates vary among patients with cancers of different anatomic sites. Further examination of the psychological experience of patients with cancer, particularly that of patients with certain types of cancer, is warranted.
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Affiliation(s)
- Stephanie Misono
- Department of Otolaryngology/Head and Neck Surgery, Universityof Washington, Seattle, WA 98195, USA.
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Dormer NRC, McCaul KA, Kristjanson LJ. Risk of suicide in cancer patients in Western Australia, 1981-2002. Med J Aust 2008; 188:140-3. [PMID: 18241168 DOI: 10.5694/j.1326-5377.2008.tb01555.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 08/23/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the incidence and risk of suicide in cancer patients in Western Australia from 1981 to 2002. DESIGN, SETTING AND PATIENTS Retrospective cohort study of patients diagnosed with cancer in WA from 1981 to 2002, using data from the WA Linked Database. MAIN OUTCOME MEASURE Age-standardised mortality ratios (SMRs). RESULTS A total of 121 533 patients were diagnosed with cancer, corresponding to a total of 543 696 person-years at risk. There were 129 suicides in this group (108 in men). The SMR for suicide in cancer patients was 1.61 (95% CI, 1.36-1.92). An initial period of peak risk was seen in the first 3 months after cancer diagnosis (SMR, 5.75; 95% CI, 3.89-8.51), mainly in patients with a poor prognosis. A second peak period of risk was found to occur 12-14 months after diagnosis (SMR, 2.33; 95% CI, 1.11-4.89) in those with a good or moderate prognosis. CONCLUSION The rate of suicide in cancer patients in WA is low and represents an excess of two to three suicides per year, or 0.3% of all cancer deaths, comparable to studies in other Western countries. The risk is highest in the first 3 months after diagnosis, and a second period of increased risk 12-14 months after diagnosis may occur in response to cancer recurrence or treatment failure.
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Affiliation(s)
- Nigel R C Dormer
- Western Australian Centre for Cancer and Palliative Care, Curtin University of Technology, Perth, WA, Australia.
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Correlates of Suicide Ideation in a Population-Based Sample of Cancer Patients. J Psychosoc Oncol 2008; 26:49-62. [DOI: 10.1300/j077v26n02_04] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rodin G, Zimmermann C, Rydall A, Jones J, Shepherd FA, Moore M, Fruh M, Donner A, Gagliese L. The desire for hastened death in patients with metastatic cancer. J Pain Symptom Manage 2007; 33:661-75. [PMID: 17531909 DOI: 10.1016/j.jpainsymman.2006.09.034] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 09/25/2006] [Accepted: 09/25/2006] [Indexed: 11/22/2022]
Abstract
A substantial minority of patients in palliative care settings report a high desire for hastened death (DHD), in association with physical and emotional distress, low social support, and impaired spiritual well being. To clarify to what extent DHD emerges in association with suffering prior to the end of life, we determined its prevalence and correlates in ambulatory patients with metastatic cancer, the majority of whom had an expected survival of >6 months. We hypothesized that DHD in this sample would be directly linked to physical and psychological distress, and inversely related to perceived social support, self-esteem, and spiritual well being. Three hundred twenty-six outpatients completed the Schedule of Attitudes Toward Hastened Death (SAHD), Brief Pain Inventory, Memorial Symptom Assessment Scale, Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Medical Outcomes Study Social Support Survey, FACIT-Spiritual Well-Being Scale, Rosenberg Self-Esteem Scale, and Karnofsky Performance Status. Over 50% of participants reported pain, >20% reported elevated levels of depression (BDI-II> or =15) and hopelessness (BHS> or =8), but <2% had a high DHD (SAHD> or =10). DHD was correlated positively with hopelessness, depression, and physical distress, and negatively with physical functioning, spiritual well being, social support, and self-esteem; it was not associated with treatment status or proximity to death. Over 34% of the variance in predicting SAHD scores was accounted for by hopelessness, depression, and functional status. The relative absence of a strong DHD in this sample suggests that the will to live tends to be preserved in cancer patients prior to the end of life, in spite of significant emotional and physical suffering.
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Affiliation(s)
- Gary Rodin
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada.
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Camidge DR, Stockton DL, Frame S, Wood R, Bain M, Bateman DN. Hospital admissions and deaths relating to deliberate self-harm and accidents within 5 years of a cancer diagnosis: a national study in Scotland, UK. Br J Cancer 2007; 96:752-7. [PMID: 17299389 PMCID: PMC2360070 DOI: 10.1038/sj.bjc.6603617] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The risk of suicide in cancer patients has been reported as elevated in several countries. These patients are exposed to many medicines that may confuse or provide a means for harm, potentially also increasing their risk from accidents. Ratios of observed/expected numbers of hospital admission and death events relating to deliberate self-harm (DSH) and accidents were calculated in the 5 years from a cancer diagnosis in Scotland 1981–1995, compared to the matched general population. The relative risk (RR) of suicide was 1.51 (95% confidence interval (CI): 1.29–1.76). The RR of hospital admissions for DSH was not significantly increased, suggesting a strong suicidal intent in DSH acts in cancer patients. Accidental poisonings and all other accidents were both increased (RR death=3.69, 95% CI: 2.10–6.00; and 1.58, 95% CI: 1.48–1.69, respectively) (RR hospital admissions=1.32, 95% CI: 1.19–1.47; and 1.55, 95% CI: 1.53–1.57, respectively). The association of only certain tumour types (e.g. respiratory) with suicide and accidental poisoning, and a broad range of tumour types with an elevated risk of all other accidents, suggests accidental poisoning categories may be a common destination for code shifting of some DSH events. A previous history of DSH or accidents, significantly increased the RR of suicide or fatal accidents, respectively (RR suicide=14.86 (95% CI: 4.69–34.97) vs 1.16 (95% CI: 0.84–1.55)) (RR accidental death=3.37 (95% CI: 2.53–4.41) vs 1.29 (95% CI: 1.12–1.49)). Within 5 years of a cancer diagnosis, Scottish patients are at increased RR of suicide and fatal accidents, and increased RR of hospital admissions for accidents. Some of these accidents, particularly accidental poisonings, may contain hidden deliberate acts. Previous DSH or accidents are potential markers for those most at risk, in whom to target interventional techniques.
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Affiliation(s)
- D R Camidge
- University of Edinburgh, Edinburgh Cancer Centre, Western General Hospital, Crewe Road, Edinburgh, UK.
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Abstract
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.
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Affiliation(s)
- W S Kendal
- Division of Radiation Oncology, The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
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Mystakidou K, Rosenfeld B, Parpa E, Tsilika E, Katsouda E, Galanos A, Vlahos L. The schedule of attitudes toward hastened death: Validation analysis
in terminally ill cancer patients. Palliat Support Care 2005; 2:395-402. [PMID: 16594402 DOI: 10.1017/s1478951504040520] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The faithful translation of the English version of
the Schedule of Attitudes toward Hastened Death (SAHD) into Greek and its
validation as an assessment tool in terminally ill cancer patients
receiving palliative treatment.Methods: 120 terminally ill cancer patients attending a
Palliative Care Unit, at the University of Athens, Greece, between June
2003 and November 2003 for palliative treatment.Results: SAHD would be a useful instrument for measuring
desire for hastened death with valid psychometric properties in a Greek
cancer population. The SAHD demonstrated high reliability. Desire for
hastened death was significantly associated with Hospital Anxiety and
Depression Scale (HAD) depression (r = 0.607, p <
0.0005) and substantially correlated with HAD anxiety (r = 0.502,
p < 0.0005). “Pain intensity” had a moderate
correlation with SAHD scores (r = 0.28, p = 0.01) and
SAHD scores correlated significantly with “pain interference in
mood” (r = 0.38, p = 0.01) and in “enjoyment
of life” (r = 0.34, p = 0.03). SAHD correlation
with quality of life was statistically significant (r =
−0.38, p < 0.01) as was health status (r =
−0.36, p < 0.01). Patients with a Poor Performance
Status (from Eastern Cooperative Oncology Group scale) correlated
significantly with high scores in SAHD (p = 0.038). Factor
analysis supported the unidimentionality of the measurement.Significance of results: SAHD could be a useful and valid
instrument for measuring desire for hastened death in Greek terminally ill
cancer patients.
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Affiliation(s)
- Kyriaki Mystakidou
- Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, 27 Korinthias Str., 115 26 Athens, Greece.
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Abstract
Compared to the general population, the suicide risk among Danish cancer patients diagnosed in 1971–1986 was increased by 50% for men and 30% for women. We updated the earlier study to evaluate both long-term and recent trends in the suicide risk. Cancer patients with a first cancer diagnosed between 1971 and 1999 in Denmark were followed-up for completed suicide through 1999. Excluding nonmelanoma skin cancer, 564 508 cancer patients were included and 1241 suicides observed. Both the standardised mortality ratio (SMR) of suicide relative to the general population and the suicide rates were analysed with Poisson regression methods. The overall SMR was increased to 1.7 (95% CI. 1.6–1.9) for men and 1.4 (95% CI: 1.3–1.5) for women. Following the cancer diagnosis, the suicide risk was highest in the first 3 months for men and between months 3 and 12 for women. The risk was higher for nonlocalised cancer and for cancers with perceived poor prognosis. Breast cancer patients had a higher risk than other cancer patients with similar good prognosis. The suicide rates among cancer patients decreased with calendar time, but less so than the rates in the general population. The suicide risk among cancer patients has not decreased as much as in the Danish population and reasons for this should be explored. Breast cancer might be believed by patients to be more life threatening than it is. Assessment and treatment of depression could improve the quality of life for cancer patients who suffer from unrecognised depressions and in turn reduce the risk of suicide in cancer patients.
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Affiliation(s)
- U Yousaf
- Department of Cancer Prevention and Documentation, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark
| | - M-LM Christensen
- Department of Cancer Prevention and Documentation, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark
| | - G Engholm
- Department of Cancer Prevention and Documentation, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark
- Department of Cancer Prevention and Documentation, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark. E-mail:
| | - H H Storm
- Department of Cancer Prevention and Documentation, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen Ø, Denmark
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Abstract
Purpose Suicide risk is reportedly higher for cancer patients than for the general population, but estimates vary and analyses of trends are few. The aim of the present study was to determine whether cancer patients had a higher suicide risk between 1960 and 1999. Patients and Methods A cohort comprising patients from the Cancer Registry of Norway 1960 to 1997 was linked to suicide diagnosis in the Register of Deaths at Statistics Norway and observed during 1960 to 1999. The cohort consisted of all cancer patients registered in the Cancer Registry of Norway 1960 to 1997 (N = 490,245 patients with 520,823 cancer diagnoses). Suicide was defined according to death certificates based on the International Classification of Diseases (versions 7, 8, 9, and 10). Results During the period, 589 cancer patients (407 males and 182 females) committed suicide. The relative risk was elevated for males and females, with standardized mortality ratios (SMRs) of 1.55 (95% CI, 1.41 to 1.71) and 1.35 (95% CI, 1.17 to 1.56), respectively. Risk was highest in the first months after diagnosis. For both sexes, there was a significant decrease in the relative suicide risk over decades. The risk was markedly increased among male patients with cancer of respiratory organs (SMR, 4.08; 95% CI, 2.96 to 5.47). Otherwise, the SMRs varied from 0.76 to 3.67 across cancer types. Conclusion Cancer may be a risk factor for suicide, particularly shortly after diagnosis. However, the relative risk gradually decreased during the period 1960 to 1999.
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Affiliation(s)
- Erlend Hem
- Department of Behavioral Sciences in Medicine, University of Oslo, PO Box 1111 Blindern. NO-0317 Oslo, Norway.
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Miccinesi G, Crocetti E, Benvenuti A, Paci E. Suicide mortality is decreasing among cancer patients in Central Italy. Eur J Cancer 2004; 40:1053-7. [PMID: 15093582 DOI: 10.1016/j.ejca.2003.12.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Revised: 11/25/2003] [Accepted: 12/20/2003] [Indexed: 10/26/2022]
Abstract
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.
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Affiliation(s)
- G Miccinesi
- Clinical Epidemiology, Centre for the Study and Prevention of Cancer, Florence, Via S.Salvi 12, 50135 Florence, Italy.
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Innos K, Rahu K, Rahu M, Baburin A. Suicides among cancer patients in Estonia: a population-based study. Eur J Cancer 2003; 39:2223-8. [PMID: 14522382 DOI: 10.1016/s0959-8049(03)00598-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The objective of this study was to determine the suicide risk among cancer patients in Estonia. This risk was examined in a cohort of 65,419 persons diagnosed with cancer in 1983-1998. Standardised mortality ratios (SMR) were calculated using the suicide rates of the population of Estonia as a reference. During 192,078 person-years of follow-up between 1983 and 2000, 197 suicides occurred in the cohort. An increased suicide risk was found for men (SMR=1.73; 95% Confidence Interval (CI) 1.45-2.01), but not for women (SMR=0.50; 95% CI 0.37-0.66). Men had the highest risk 90-179 days following their diagnosis (SMR=4.27; 95% CI 2.81-6.21). During this time interval, among men, the risk was more pronounced for cancers of the oesophagus (SMR=35.63; 95% CI 9.71-91.22) and pancreas (SMR=14.53; 95% CI 1.76-52.50). This study provides further evidence that cancer is a risk factor for suicide, at least in men.
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Affiliation(s)
- K Innos
- Department of Epidemiology and Biostatistics, Institute of Experimental and Clinical Medicine, Hiiu 42, 11619 Tallinn, Estonia
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Akechi T, Okamura H, Nishiwaki Y, Uchitomi Y. Predictive factors for suicidal ideation in patients with unresectable lung carcinoma. Cancer 2002; 95:1085-93. [PMID: 12209695 DOI: 10.1002/cncr.10769] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite serious concern over the suicidality of cancer patients in clinical oncology practice, few studies have addressed this issue. The purpose of the current study was to investigate the prevalence and predictive factors of suicidal ideation in patients with unresectable lung carcinoma in a follow-up setting. METHODS Patients with newly diagnosed unresectable nonsmall cell lung carcinoma participated in this study. Their suicidal ideation was assessed 6 months after disclosure of the cancer diagnosis. Predictive factors for suicidal ideation were investigated by assessing a broad range of biomedical and psychosocial factors between the time of disclosure and start of cancer therapy (baseline) and 6 months after disclosure of the cancer diagnosis (follow-up). RESULTS Although strong suicidal ideation was rare in this population, 13 (15%) of the 89 subjects who completed the baseline and follow-up ratings had some degree of suicidal ideation 6 months after disclosure of the cancer diagnosis. Univariate analysis revealed that significant predictive factors for suicidal ideation were pain at baseline, declining physical function, and the development of a depressive disorder. Multivariate analysis indicated that pain at baseline (odds ratio [OR] = 3.72, 95% confidence interval [CI] = 1.12-14.69, P = 0.04) and the development of a depressive disorder (OR =27.97, 95% CI = 5.18-214.14, P = 0.0003) were the final significant predictive factors. CONCLUSIONS Suicidal ideation among unresectable lung carcinoma patients should not be neglected because it is not rare. Comprehensive care consisting of at least earlier pain management and appropriate psychiatric intervention is indispensable to prevent subsequent suicidal ideation.
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Affiliation(s)
- Tatsuo Akechi
- Psycho-Oncology Division, National Cancer Center Research Institute East, Chiba, Japan
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