A Literature Review of Suicide in Cancer Patients

Linda Anguiano, MSN, RN; Deborah K. Mayer, PhD, RN, AOCN, FAAN; Mary Lynn Piven, PhD, PMHCNS-BC; Donald Rosenstein, MD

Disclosures

Cancer Nurs. 2012;35(4):E14-e26. 

In This Article

Abstract and Introduction

Abstract

Background: Cancer survivors have a higher suicide rate than the general population. Oncology nurses need to have knowledge and skills in assessing risk for suicide in this population.
Objective: This study aimed to conduct a literature review on risk factors for and incidence of suicide in patients with cancer and to identify potential screening tools.
Methods: PubMed, CINAHL, and PsycINFO databases were searched to identify research articles in peer-reviewed journals from 1999 to 2009. The variables under study included suicide rate, cancer type, demographic characteristics, and signs and symptoms associated with suicide. In addition, articles focused on suicide risk assessment tools were also included.
Results: Twenty-four articles met the inclusion criteria. As in the general population, suicide risk was higher among men with cancer as compared with women with cancer. Patients aged 65 years or older with cancer have a higher rate of suicide compared with those younger than 65 years, with rates highest among men 80 years or older. Specific diagnoses associated with higher suicide rates include prostate, lung, pancreatic, and head and neck cancers. The first year after diagnosis carries a higher risk for completed suicide. Multiple risk assessment tools have been developed and are effective in identifying patients with depression or hopelessness, factors associated with higher risk for suicide. However, no tools exist that sensitively and specifically predict suicide.
Conclusion: The incidence of suicide in someone with a cancer diagnosis is approximately double the incidence of suicide in the general population. Early detection of depression in special cancer populations, such as older male patients, may help identify those at greatest suicide risk.
Implications for Practice: Oncology nurses should be aware of cancer patients considered at higher risk for suicide. Systematic screening for suicidal ideation and behavior may identify cancer patients at high risk and facilitate appropriate mental health evaluation and treatment.

Introduction

Suicide was ranked as the 11th leading cause of death in the United States, responsible for 33,289 deaths[1] in 2006. Risk factors associated with suicide in the general population include chronic diseases, pain, depression, both older age and youth, living alone, and unemployment. Gender also influences suicide rates with males at 4 times higher risk of suicide than females. Suicide was the seventh leading cause of death for males and the 16th for women[2] in 2006. In addition, Americans 65 years or older have a higher incidence of suicide. According to the National Institute of Mental Health, 14.2 of 100,000 older Americans died as a result of suicide in 2006 as compared to 10.6 of 100,000 people in the general population. More than 90% of people who commit suicide in the general population have depression, mental illness, and/or substance abuse.[2]

The suicide rate for persons with cancer is estimated to be twice the rate in the general US population.[3] Yet oncology nurses are often unable to identify factors that may put the cancer patient at higher risk.[4] Failure to recognize suicide risk in patients with cancer may lead to further morbidity and mortality. Therefore, the purpose of this review of the literature was to identify (1) risk factors associated with suicide in cancer patients and (2) evidence-based assessment methods.

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