The desire to hasten death in advanced cancer patients at a Mexican palliative care service

Abstract

Introduction. The desire to hasten death (DHD) might be present in patients with advanced cancer. Multiple distressing physical and psychosocial symptoms may be related to it. There is limited literature about the characteristics of these patients in México. Objective. To describe the prevalence and factors associated with DHD in advanced cancer patients evaluated by a palliative care psychiatrist. Method. We conducted a cross-sectional study, including all patients referred to psychiatric assessment at the Servicio de Cuidados Paliativos of the Instituto Nacional de Cancerología in Mexico City, from January to December 2016. DHD was defined as the presence of death ideas, suicidal ideation, and/or request for euthanasia or medically assisted suicide. Patients with delirium, dementia, psychosis, or uncontrolled physical symptoms were excluded. Results. Sixty-four patients were included in the study. Most of them were women (59%); the mean age was 49 years old (SD = 16). Of them, 64% met criteria for a major depressive disorder, 64% for generalized anxiety disorder and/or panic disorder, and 11% for substance use disorders. 44% expressed DHD. In a multivariate regression analysis predicting DHD, only one factor emerged: clinical depression (OR = 13.5, p = .002, 95% CI [02.562, 71.726]). Discussion and conclusion. The desire to hasten death is a frequent issue for the patients evaluated at the psychiatric palliative care clinic. Depression and other distressing psychiatric pathologies were associated with DHD. Interdisciplinary interventions are needed to treat DHD. More research is warranted in order to understand the factors associated with the expression of DHD.Keywords: Desire to hasten death, advanced cancer, palliative care, depression. RESUMENIntroducción. El deseo de acelerar la muerte (DHD, por sus siglas en inglés) es frecuente en pacientes con cáncer avanzado. Múltiples estresores físicos y psicosociales se asocian a la presencia de este fenómeno. En México es limitada la información sobre estos pacientes. Objetivo. Describir la prevalencia y los factores asociados con la presencia del DHD en pacientes con cáncer avanzado evaluados por el psiquiatra de cuidados paliativos. Método. Realizamos un estudio transversal, incluimos a todos los pacientes referidos a evaluación psiquiátrica en el Servicio de Cuidados Paliativos del Instituto Nacional de Cancerología en la Ciudad de México, de enero a diciembre de 2016. El DHD se definió como la presencia de ideas de muerte, ideación suicida y/o solicitud de eutanasia o suicidio médicamente asistido. Se excluyeron los pacientes con delirium, demencia, psicosis o algún síntoma físico descontrolado. Resultados. Sesenta y cuatro pacientes fueron incluidos en el estudio; 59% fueron mujeres; la edad media era de 49 años (DE = 16). El 64% cumplieron criterios para un trastorno depresivo mayor, el 64% para el trastorno de ansiedad generalizada y/o trastorno de pánico y el 11% para los trastornos por uso de sustancias; 44% expresaron DHD. En un análisis de regresión multi...

The desire for death in Portuguese home-care palliative patients: Retrospective analysis of the prevalence and associated factors

“…To the best of our knowledge, this study is the first to describe the prevalence and associated factors of the DfD of palliative patients cared for in a HPCU. Our results indicate that 20% of patients endorse a significant and persistent desire for hastened death are aligned with earlier studies (Chochinov et al, 1995;Rodríguez-Mayoral et al, 2019), along with the Portuguese research by Julião et al (2013) in terminally ill persons in a PC Unit.…”

Comparing the hospital anxiety and depression scale to the Brief Edinburgh Depression Scale for identifying cases of major depressive disorder in advanced cancer palliative patients

“…The benefits of improving MDD diagnosis in advanced cancer patients are considerable. Timely diagnosis translates to improved treatment and better mental health which could impact in quality of life, physical symptoms, treatment compliance, suicidal risk, wish to hasten death, and survival rates (Lloyd-Williams et al, 2004; Kroenke et al, 2010; Pinquart and Duberstein, 2010; Rodríguez-Mayoral et al, 2019, 2020). Large-scale studies with considerable follow-up have consistently shown the beneficial effect of depression treatment in patients with good or bad prognosis malignancies, both in terms of reducing major depression and improving quality of life (Mulick et al, 2018).…”

“…In addition to its high frequency, MDD represents a source of morbidity and negatively impacts survival in patients with advanced cancer. Among its many repercussions, MDD is associated with worse functioning, survival rates, quality of life, and treatment compliance, as well as with wishes to hasten death and a higher frequency and intensity of physical symptoms (Lloyd-Williams et al, 2004; Kroenke et al, 2010; Pinquart and Duberstein, 2010; Rodríguez-Mayoral et al, 2019, 2020). Although it is a common complication, it is underdiagnosed and therefore undertreated (Sharpe et al, 2004).…”

Perfil de pacientes em cuidados paliativos que apresentam ideação suicida: revisão sistemática [Profile of palliative care patients who display suicidal ideation: a systematic review] [Perfil de pacientes en cuidados paliativos que presentan ideación suicida: revisión sistemática]

“…A duração média da sobrevida até a morte variou de 63 dias a 29,96 meses [13][14]17 . Os tipos mais prevalentes de câncer foram de próstata [18][19][20] , pulmão 12,18 , ginecológicos 19 , mama 19 e colo retal 20 . Apenas um estudo foi realizado com pacientes diagnosticados com HIV 16 .…”

“…A pesquisa desenvolvida nos EUA, a partir de registros de 64 suicídios concretizados de pacientes com câncer, identificou que 44,0% dos suicídios aconteceram durante a abordagem paliativa, 38,0% possuíam prognóstico ruim, 47,0% apresentavam dor e 17,0% problemas de sono 18 . Em contrapartida, outro estudo levantado aponta que os cuidados paliativos foram associados à diminuição da probabilidade de suicídio (OR=0,19; 0,08 -0,47) 12 .…”