Suicide Risk in Cancer Patients
Demographics and Statistics
Etiology/Pathophysiology
Demographics and Statistics
Studies indicate that the incidence of suicide in cancer patients can be equal
to the incidence in the general population or up to 2 to 10 times as frequent.
Some studies suggest that while relatively few cancer patients commit suicide,
they are at increased risk for suicide.[1-3] One population-based study utilizing data from the Cancer Registry of Norway linked to the Register of Deaths at Statistics Norway indicated an increased relative risk of suicide in the decade 1990-1999 within 2 years of diagnosis for males and females; however, the relative risk for females was nonsignificant. For both sexes, the risk was highest in the first months after diagnosis, and there was a significant decrease in relative risk over decades.[4] Passive suicidal thoughts are
relatively common among cancer patients. The relationships between suicidal
tendency and the desire for hastened death, requests for physician-assisted
suicide, and/or euthanasia are complex and poorly understood.[5] Men with
cancer are clearly at an increased risk of suicide compared with the general
population, with a relative risk as high as 2.3.[1,2] Overdosing with
analgesics and sedatives is the most common method of suicide among persons
with cancer,[1,2] with most cancer-related suicides occurring at home. Reports
identify a higher incidence of suicide in patients with oral, pharyngeal, and
lung cancers and in HIV-positive patients with Kaposi sarcoma.[1,2,5] The
actual incidence of suicide in cancer patients is probably underestimated.
There may be reluctance to report death by suicide in these circumstances.[6]
Etiology/Pathophysiology
Risk factors for suicide in the cancer population are as follows:
General Risk Factors
- History of psychiatric disorders, especially those associated with
impulsive behavior (e.g., borderline personality disorders).
- Family history of suicide.
- History of previous/prior suicide attempts.
- Depression.
- Substance abuse.
- Recent death of a friend or spouse.
- Few social supports.
Cancer-Specific Risk Factors
- Oral, pharyngeal, and lung cancers (often associated with heavy alcohol
and tobacco use).
- Advanced stage of disease and poor prognosis.
- Confusion/delirium.
- Inadequately controlled pain.
- Presence of deficit symptoms (e.g., loss of mobility, loss of bowel and
bladder control, amputation, sensory loss, paraplegia, inability to eat
and to swallow, exhaustion, fatigue).
References
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Bolund C: Suicide and cancer: I. Demographic and social characteristics of cancer patients who committed suicide in Sweden, 1973-1976. Journal of Psychosocial Oncology 3 (1): 17-30, 1985.
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Bolund C: Suicide and cancer: II. Medical and care factors in suicides by cancer patients in Sweden, 1973-1976. Journal of Psychosocial Oncology 3 (1): 31-52, 1985.
-
Fox BH, Stanek EJ 3rd, Boyd SC, et al.: Suicide rates among cancer patients in Connecticut. J Chronic Dis 35 (2): 89-100, 1982.
[PUBMED Abstract]
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Hem E, Loge JH, Haldorsen T, et al.: Suicide risk in cancer patients from 1960 to 1999. J Clin Oncol 22 (20): 4209-16, 2004.
[PUBMED Abstract]
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Breitbart W, Krivo S: Suicide. In: Holland JC, Breitbart W, Jacobsen PB, et al., eds.: Psycho-oncology. New York, NY: Oxford University Press, 1998, pp 541-7.
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Holland JC: Psychologic aspects of cancer. In: Holland JF, Frie E, eds.: Cancer Medicine. 2nd ed. Philadelphia, Pa: Lea & Febiger, 1978, pp 1175-1203.
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