Cancer patients often think about ending their lives and their suicide rate is roughly twice that seen in the general population, according to the results of three studies appearing in the Journal of Clinical Oncology.
In a survey of 2 924 cancer outpatients treated at one regional cancer center, Dr Jane Walker, from the Royal Edinburgh Hospital in the UK, and colleagues found that 7.8 percent of the patients thought they would be "better off dead", or had considered hurting themselves in some way within the last two weeks.
Emotional distress was the strongest predictor of suicidal thoughts, followed by substantial pain, and older age, the report indicates.
"Management of emotional distress and pain should be a central aspect of cancer care," the investigators emphasise.
Race, age and gender play a role
In another study, Dr Stephanie Misono, from the University of Washington in Seattle, and colleagues assessed the cancer-related suicide rates using the Surveillance, Epidemiology, and End Results program, a large national database containing information for nearly 3.6 million patients diagnosed with a malignancy between 1973 and 2002.
A total of 5 838 suicides occurred, yielding a rate of 31.4 suicides per 100 000 people per year, which is nearly twice as high as the rate of 16.7 suicides per 100 000 people per year in the general population.
Male gender, white race, and older age at diagnosis were all linked with an increased risk of suicide. Patients with lung cancer had the highest suicide risk, followed by patients with malignancies of the stomach, mouth, throat and windpipe. The suicide risk was greatest within the first five years of diagnosis.
In a third study, Dr Matthew Miller, from Harvard School of Public Health in Boston, and colleagues show that cancer is the only common medical condition that carries an elevated risk of suicide among older adults. His group noted that the rate was more than twice as high as that of the general population.
Their study included over 1 400 patients with a variety of illnesses, such as diabetes, heart disease, and chronic lung disease. All of the subjects were at least 65 years old and New Jersey residents.
Antidepressants up risk
The risk of suicide was also increased among those with psychiatric diagnoses, primarily mood disorders, such as depression; these patients had 2.3 times the risk. Anxiety and personality disorders were linked with a 2.2 times increased risk of suicide.
Antidepressant use and treatment with opioid pain medications, such as morphine, were also tied to an increased risk.
The higher risk of suicide among cancer patients persisted even after concurrent psychiatric illness and the risk of dying with one year were considered.
In a related editorial, Dr Timothy E. Quill, from the University of Rochester Medical Center in New York, comments that "lessening suffering of seriously ill patients though the diligent application of palliative measures, and alleviating their aloneness and despair by maintaining an open, committed, receptive relationship may be the most important preventive measures with regard to suicide." – (Reuters Health, August 2008)
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