Suicide Risk in Cancer Patients

Demographics and Statistics
Etiology/Pathophysiology

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]

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

1. 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. 
   
   
2. 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. 
   
   
3. 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]
   
   
4. 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]
   
   
5. 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. 
   
   
6. Holland JC: Psychologic aspects of cancer. In: Holland JF, Frie E, eds.: Cancer Medicine. 2nd ed. Philadelphia, Pa: Lea & Febiger, 1978, pp 1175-1203.