Better Off Dead: Suicidal Thoughts in Cancer Patients

Walker, Jane; Waters, Rachel; Murray, Gordon D.; Swanson, H. Lee; Hibberd, Carina; Rush, Robert; Storey, Dawn J; Strong, Vanessa; Fallon, Marie; Wall, Lucy; Sharpe, Michael

doi:10.1200/jco.2007.11.8844

Cited by 177 publications

(175 citation statements)

References 45 publications

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“…48 Increased suicide rates have been observed among all people with cancer, 49 and rates for suicidal ideation for women in our study parallel the 7.2% reported for patients with bowel cancer in a recent study of patients from an outpatient clinic in a regional cancer center in Edinburgh. 50 We also found a trend for worse current feelings of depression (scaled item) among men with ostomies (P ϭ .08), with a significant difference for women with ostomies (P ϭ .007). While prior research has shown depression in this population, 51,52 our findings are novel in describing postoperative states, including risk of suicide, which must be addressed in the perioperative setting.…”

Section: Discussionmentioning

confidence: 58%

Health-Related Quality of Life Among Long-Term Rectal Cancer Survivors With an Ostomy: Manifestations by Sex

Krouse

Herrinton²,

Grant³

et al. 2009

JCO

196

171

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A B S T R A C T PurposeIntestinal stomas can pose significant challenges for long-term (Ն 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL). Patients and MethodsThis was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOLOstomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status. Results Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics.On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (Ͻ age 75 years), ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores. ConclusionMen and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75.

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Section: Discussionmentioning

confidence: 58%

Health-Related Quality of Life Among Long-Term Rectal Cancer Survivors With an Ostomy: Manifestations by Sex

Krouse

Herrinton²,

Grant³

et al. 2009

JCO

196

171

View full text Add to dashboard Cite

show abstract

“…Studies (Henriksson et al, 1995;Akechi et al, 2001Akechi et al, , 2002aFiliberti et al, 2001;Smith et al, 2004;Walker et al, 2008) have consistently shown that substantial pain, major depression, loss of autonomy and independence, emotional distress and impaired physical functioning are the clinical factors most commonly associated with suicidal thoughts in cancer patients. One recent survey of nearly 3000 cancer patients attending a regional cancer centre in Scotland found that almost 8% reported having thoughts of being better off dead or of hurting themselves in some way for at least several days in the previous 2 weeks (Walker et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Suicide in cancer patients in South East England from 1996 to 2005: a population-based study

et al. 2009

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BACKGROUND: Studies from around the world have shown that suicide risk is increased in cancer patients, but no previous detailed analysis has been carried out in England. METHODS: We calculated standardised mortality ratios (SMRs) for suicide in 206 129 men and 211 443 women diagnosed with cancer in South East England between 1996 and 2005, relative to suicide rates in the general population. RESULTS: We found a significantly increased risk of suicide in men (SMR 1.45, 95% confidence interval (CI) 1.20 -1.73) and a moderately increased risk in women (SMR 1.19, 95% CI 0.88 -1.57). In both sexes, relative risk of suicide was greatest in the first year after cancer diagnosis (SMR for men 2.42, 95% CI 1.84 -3.13; SMR for women 1.44, 95% CI 0.82 -2.33), and was also greater in individuals diagnosed with types of cancer with high fatality (SMR for men 2.67, 95% CI 1.71 -3.97; SMR for women 2.17, 95% CI 0.80 -4.73). CONCLUSION: There is a critical period immediately after the diagnosis of cancer during which the excess risk of suicide is particularly high. Carers need to be aware of the importance of attending to both the physical and emotional needs of cancer patients and cancer survivors.

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“…In one report, increasing age was paralleled by an increasing likelihood for thoughts of hurting oneself or feeling "better off dead." 61,62 The incidence of suicide has, in fact, been noted to be higher among older adults with cancer compared with older adults diagnosed with another medical illness. 63 The use of psychosocial interventions may be effective in this population, and the majority of randomized controlled trial (RCT) data assessing psychosocial interventions support this strategy.…”

Section: Psychological Statementioning

confidence: 99%

“…78 Notably, both medications are frequently used in the treatment of oncology patients (warfarin for cancer-related thrombosis, and benzodiazepines for the management of anxiety or chemotherapyrelated emetogenesis). 62,63 Pharmacist-based medication review programs may reduce polypharmacy and the associated frequency of ADRs, although follow-up is needed to determine whether such programs have a substantial impact on clinical outcome in older adults with cancer. 79 …”

Section: Polypharmacymentioning

confidence: 99%

Evaluating the Older Patient with Cancer: Understanding Frailty and the Geriatric Assessment

Pal¹,

Katheria²,

Hurria³

2010

CA: A Cancer Journal for Clinicians

221

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The majority of cancer incidence and mortality occurs in individuals aged older than 65 years, and the number of older adults with cancer is projected to significantly increase secondary to the aging of the US population. As such, understanding the changes accompanying age in the context of the cancer patient is of critical importance. Agerelated changes can impact tolerance of anticancer therapy and can shift the overall risk-benefit ratio of such treatment. A challenge in implementing evidence-based approaches in older adults is the under-representation of this group in oncology clinical trials. In addition, although older adults are particularly vulnerable to the side effects of cancer therapy, few oncology studies to date have incorporated a measure of health status other than the Eastern Cooperative Oncology Group or Karnofsky performance scales. Novel metrics such as frailty indices or the geriatric assessment recognize heterogeneity among older adults, and may allow for risk-adapted approaches to therapy. It is increasingly recognized that several laboratory markers may predict morbidity and mortality in older adults; these biologic variables may further aid in stratifying this group of patients based on risk. This review describes key studies from the geriatric literature that provide principles for assessing health status in the older patient, and ways that these principles can be applied to oncology care in an older population are proposed. CA Cancer J Clin 2010;60:120-132.

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Better Off Dead: Suicidal Thoughts in Cancer Patients

Abstract: A substantial number of cancer outpatients report thoughts that they would be better off dead or thoughts of hurting themselves. Management of emotional distress and pain should be a central aspect of cancer care.

Cited by 177 publications

References 45 publications

Health-Related Quality of Life Among Long-Term Rectal Cancer Survivors With an Ostomy: Manifestations by Sex

Health-Related Quality of Life Among Long-Term Rectal Cancer Survivors With an Ostomy: Manifestations by Sex

Suicide in cancer patients in South East England from 1996 to 2005: a population-based study

Evaluating the Older Patient with Cancer: Understanding Frailty and the Geriatric Assessment

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