Risk factors for suicide in individuals with cancer
Article in review: Mendes M., Santos S., Ceballos, A., Furtado B. & Bonfim C. (2021). Risk factors for suicide in individuals with cancer: an integrative literature review. Psychiatric Nursing & Mental Health. https://doi.org/10.1590/0034-7167-2019-0889
Although it can still be considered a relatively rare occurrence, there is an elevated risk of suicide among people with cancer. Factors such as depression, helplessness, hopelessness, changed relationships and loss of sexual function can all be considered risk factors. This integrative literature review has sought to identify particular risk factors and draw correlations between these risks and types of cancers, and at particular time points during a cancer diagnosis, treatment and duration. There is a benefit for cancer specialists in understanding, assessing and recognising these risks.
Cancer and suicide
Cancer is currently the second leading cause of death around the world, and by 2030 it is likely to be the cause of death for one in six people. Cancer is a chronic disease, a diagnosis of which may impact a person’s mental health, contributing to mood swings, insomnia and depression.
We know that depression is a condition that is a risk factor for suicide. Several studies from around the world have also shown an increase in suicide rates amongst individuals with cancer.
This study has sought to consolidate our knowledge of the relationship between suicide and cancer, through an integrative literature review. Reasons for increased rates of suicide among people with cancer include:
• Poor prognosis
• Disease progression level
• Symptoms of depression
• Feelings of helplessness
• Disturbances of interpersonal relationships
• Uncontrolled pain
Other risk factors for people with cancer include:
• Psychiatric history
• Previous suicide attempts
• Lack of social support
• Feeling of being a burden
• Existential concerns (regret, loss of meaning, purpose or dignity)
Researchers scanned relevant databases and selected, read and assessed the resulting articles for relevance. The study included articles published in Portuguese or English, and between 2014 and 2019. A total of 1,497 articles were considered, 59 considered possibilities with 18 fitting research criteria. Of these, 17 were cohort studies, and one was a case-control study.
Risks associated with demographics
From across these studies, of those people with cancer who died by suicide, the profile shown was male, white, older than sixty years, and most commonly single. Anxiety and depression were stated risks in two studies, while advanced cancer was a risk in six studies. There was an increased risk for those with inoperable cancers and those who refused surgery. People with cancer may feel they are more of a burden to those around them and may have increased feelings of hopelessness. Both of these sentiments are very commonly recognised as significant suicide risks.
Risks associated with time
Eight articles verified the risk of suicide after a cancer diagnosis, but varied in their findings related to the period considered most risky; from one, three, and six months to first, second and up to five years after diagnosis. During the first three months, cancer patients may be experiencing stress and difficulty coping; they may see or feel symptoms and notice side effects from treatment. This can be a period of increased risk. However, there are also likely to be correlations between time and type of cancer. People with palliative forms of the disease may be at an increased risk as time goes on.
Risks associated with particular forms of cancer
It is reported necessary to pay attention to the type of cancer a person has, to identify associated risks. For example, people with a palliative form of cancer may be at greater risk than those with more treatable forms. Similarly, cancers that result in pain, incontinence or loss of sexual functions, such as genitourinary cancers might be considered to be a higher risk. Those who have surgical therapy may have their own set of risks; mutilation is a risk factor. So too are cancers where a person is required to use a colostomy bag. Cancer surgeries that result in limb loss or mutilation, changed gait or decreased strength are also contributing risk factors.
Reducing suicide risk for people with cancer
There is evidence to suggest that cancer specialists, such as oncology nurses, do not necessarily understand demographic risks for suicide amongst cancer patients and have little knowledge in assessing the risk of suicide among their patients.
Study authors acknowledge that the increased risk of suicide among people with cancer, particularly those with poor prognosis, is multifactorial. Cancer can predispose a person to suicide and cancer specialist and support professionals should be attentive to these risks. Types of cancer, time of diagnosis and demographic factors are all potential risk variables and should be considered during the course of care. Across all of these risk categories, psychotherapy is a vital suicide prevention strategy for people with cancer.