August 18, 2008

Q^uestion

"Dear Dr. Adams:

"People with terminal cancer are in horrible pain with no hope. I am wondering why many do not attempt suicide?"

A^nswer

Dr. Adams replies:   Many do attempt suicide:  "Cancer patients often think about ending their lives and their suicide rate is roughly double that seen in the general population...investigators found that 7.8% of subjects had thought they would be "better off dead" or had considered hurting themselves in some way in the last 2 weeks.

Emotional distress was the strongest predictor of suicidal thoughts, followed by substantial pain and older age.

Management of emotional distress and pain should be a central aspect of cancer care.

Male gender, white race, and older age at diagnosis were all linked to an increased suicide risk. In terms of cancer types, lung cancers carried the highest suicide risk, followed by malignancies involving the stomach, oral cavity and pharynx, and larynx. The suicide risk was greatest within the first 5 years after diagnosis. Antidepressant use and treatment with opioid analgesics were also tied to an increased risk...lessening suffering of seriously ill patients though the diligent application of palliative measures and alleviating their aloneness and despair by maintaining an open, committed, receptive relationship may be the most important preventive measures with regard to suicide."

J Clin Oncol 2008;26.