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Clinical Correlates of Suicidal Thoughts in Patients With Advanced Cancer

https://doi.org/10.1097/JGP.0b013e318233171aGet rights and content

Objective

Cancer patients are at heightened risk of suicide. Clinical correlates of suicidal ideation in advanced cancer patients were examined to identify those at risk and to inform the development of interventions to reduce suicidal ideation in this vulnerable group.

Methods

Coping with Cancer (CwC) is an NCI- and NIMH-funded multiinstitutional investigation examining psychosocial influences on the quality of life and care of advanced cancer patients. Baseline face-to-face interviews that assessed mental and physical functioning, coping, spirituality, and use of mental health services were conducted with 700 advanced cancer patients.

Results

Compared with patients without suicidal ideation, the 8.9% of patients who reported suicidal thoughts were more likely to be white and report no affiliation with an organized religion (p < 0.05). Adjusted analyses revealed that cancer patients who met criteria for current panic disorder (adjusted odds ratio [95% confidence interval] 3.24 [1.01–10.4]) and posttraumatic stress disorder (3.97 [1.13–14.1]), who accessed mental health services (3.70 [2.07–6.67]), particularly psychotherapy (2.62 [1.20–5.71]), who were not feeling well physically, and who lacked a sense of self-efficacy, spirituality, and being supported were more likely than others to report thoughts of suicide (p < 0.05).

Conclusions

Advanced cancer patients who report suicidal thoughts are more likely to meet criteria for posttraumatic stress disorder and panic disorder, feel unsupported, lack a religious affiliation, spirituality, and a sense of self-efficacy, and experience more physical distress. Palliative care interventions that promote a sense of self-efficacy, spirituality, and support while minimizing physical distress may offer promise for reducing suicidal thoughts in this at-risk group.

Section snippets

Study Sample

Patients were recruited from September 2002 to August 2008, into the Coping with Cancer (CwC) study, a multiinstitutional investigation of advanced cancer patients and their primary, informal, unpaid caregivers (National Institutes of Health grants MH63892 and CA106370: PI, Prigerson). Only data from the patient baseline interviews are included in this report. Participating sites included the Yale Cancer Center (New Haven, CT), the Veterans Affairs Connecticut Healthcare System Comprehensive

Patient Characteristics

The cohort of 700 advanced cancer patients was 72.2% white, 14.1% black, 11.5% Hispanic, 1.9% Asian, and 51.4% male (Table 1). Patients died a median of 116 days after enrollment and had the following primary cancers: gastrointestinal (24.7%), breast (9%), thoracic (25.9%), other (40.4%). Sixty-two patients (8.9%) reported thoughts of suicide. Although no gender differences emerged, being a non-Hispanic white compared with nonwhite was associated with a significantly higher prevalence of

COMMENT

This report demonstrates that there are multiple, significant clinical markers that geriatric psychiatrists and palliative care clinicians can use to identify advanced cancer patients with suicidal thoughts. The Coping with Cancer study is among the largest psychiatric epidemiologic studies of advanced cancer patients and, specifically assesses suicidality. It therefore provides useful data for elucidating the risk factors that clinicians can use to triage their patients to more rigorous

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  • Cited by (0)

    The authors indicated no potential conflicts of interest or financial disclosures. All authors have read and approved the manuscript.

    This study was approved by the human subjects committee prior to the research being conducted at each institution and all participants provided written informed consent.

    Dr. Prigerson, the principal investigator for this study, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    This research was supported in part by the following grants to Dr. Prigerson: MH63892 from the National Institute of Mental Health and CA106370 and CA156732 from the National Cancer Institute; a pilot grant from the American Foundation for Suicide Prevention; and the Center for Psycho-Oncology and Palliative Care Research, Dana-Farber Cancer Institute.

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