Suicide Risk in Cancer Patients
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. 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. 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.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.
- 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.
- 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).
- 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.
- 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]
- 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]
- 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.
- Holland JC: Psychologic aspects of cancer. In: Holland JF, Frie E, eds.: Cancer Medicine. 2nd ed. Philadelphia, Pa: Lea & Febiger, 1978, pp 1175-1203.