By Kelly Irwin, MD MPH*
Assessment of emotional well-being is an essential component of quality cancer care now mandated by the American College of Surgeons; yet oncologists receive limited guidance on when and how to screen and what to do next. Recognizing the elevated suicide risk among patients with cancer is a critical reminder for oncology clinicians to screen for distress and depression, and, when needed, to be able to rapidly connect to mental health care.
We can begin to identify a high-risk population: suicide rates are markedly elevated among patients with lung, pancreatic, and head and neck cancer.1 Among patients with lung cancer, the risk is highest immediately following cancer diagnosis: during the first week, and remains high at 3 months and 1 year.2 Additional cancer-specific factors, comorbidities, and demographics can sometimes guide oncologists: patients with advanced-stage cancer and uncontrolled pain are at elevated risk. As cancer prognosis improves, the risk of suicide may decrease, but we also know that patients with curable cancers also have higher rates of completed suicide. Similar to the general population, depression and substance use increase the risk of suicide, and older widowed males have higher rates of completed suicide. We can use validated screening approaches to assess the urgency of risk.
However, our prediction of suicide risk will always be imperfect. Oncology clinicians need to ask about depression and distress systematically, and when worried, need to be able to consult with mental health clinicians and rapidly access mental health treatment. We can take practical steps to decrease risk by evaluating access to firearms or having a family member administer medications. Importantly, depression and hopelessness are primary drivers of suicide; both are treatable, yet patients may not speak out about their symptoms. Asking about suicide as a standard part of cancer care can diffuse mental health stigma, but asking is not enough. We need to invest in integrated, flexible care delivery models, which make it easier for oncologists and patients to access mental health treatment. Increasing access to mental health care at the time of cancer diagnosis can decrease suffering and may decrease the risk of suicide, a source of preventable deaths for patients with cancer.
References
1. Kam D, Salib A, Gorgy G, et al. Incidence of Suicide in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. 2015;141:1075-1081.
2. Urban D, Rao A, Bressel M, et al. Suicide in lung cancer: who is at risk, Chest. 2013:144:1245- 1252. *Psychiatrist, Center for Psychiatric Oncology and Behavioral Sciences, Mass General Cancer Center, Harvard Medical School
