Decreasing suicide risk among patients with prostate cancer: Implications for depression, erectile dysfunction, and suicidal ideation screening

Klaassen, Zachary; Arora, Karan; Wilson, Shenelle N.; King, Sherita A.; Madi, Rabii; Neal, Durwood E.; Kurdyak, Paul; Kulkarni, Girish S.; Lewis, Ronald W.; Terris, Martha K.

doi:10.1016/j.urolonc.2017.09.007

Cited by 53 publications

(49 citation statements)

References 37 publications

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“…Most suicides occurred during treatment with palliative intent and upon initial diagnosis, which is supported by studies suggesting a greater suicide risk upon diagnosis or worsening medical status . There were a variety of known risk factors present in these cases such as depression, suicidal ideation and attempts, medical comorbidities, and pain . We were surprised to find that 67% of patients were not referred to mental health services, largely stemming from failures to recognize triggers to assess and communication issues, which are frequently reported areas in need of improvement .…”

Section: Discussionmentioning

confidence: 86%

“…18,[35][36][37][38] There were a variety of known risk factors present in these cases such as depression, suicidal ideation and attempts, medical comorbidities, and pain. [6][7][8][9][10]14,18,23,35,37,39 We were surprised to find that 67% of patients were not referred to mental health services, largely stemming from failures to recognize triggers to assess and communication issues, which are frequently reported areas in need of improvement. [23][24][25][26] These findings advance on previous studies because they illustrate the details surrounding the events, and the system-related errors that contributed to the suicides.…”

Section: Action Plansmentioning

confidence: 99%

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Factors contributing to cancer‐related suicide: A study of root‐cause analysis reports

et al. 2018

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This analysis uncovers opportunities to mitigate risk of death by suicide among patients with cancer. Suggested actions include use of comprehensive cancer centers and development of a distress checklist using information from the National Comprehensive Cancer Network Guidelines. Further studies should assess additional factors that may increase the risk of other adverse mental health outcomes in this population.

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Section: Discussionmentioning

confidence: 86%

Section: Action Plansmentioning

confidence: 99%

Factors contributing to cancer‐related suicide: A study of root‐cause analysis reports

et al. 2018

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“…However, the risk remained elevated, in comparison with the general population, even more than 5 years after the diagnosis. 24,25 Both depression and anxiety in patients with cancer are results of multiple factors. However, the study may have suffered from a sampling bias because the sample was a convenience sample from a hospital.…”

Section: Discussionmentioning

confidence: 99%

Suicidal death within a year of a cancer diagnosis: A population‐based study

Saad

Gad

Al‐Husseini

et al. 2019

Cancer

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BACKGROUND:The suicide risk after a new cancer diagnosis remains a controversial issue. This study examines the suicide risk within the year after a cancer diagnosis. This is the largest study to assess recent trends in suicide risk after a cancer diagnosis. METHODS: Data were obtained from the Surveillance, Epidemiology, and End Results Program. All patients diagnosed with cancer between 2000 and 2014 were selected. The event was defined as death due to suicide within the first year after a cancer diagnosis, and patients who experienced the event after their diagnosis were observed. The observed/expected (O/E) ratio was assessed as well as the excess risk per 10,000 person-years to determine the suicide risk change after the diagnosis in comparison with the general population. RESULTS: A total of 4,671,989 patients with cancer were included; 1585 committed suicide within 1 year of their diagnosis. The risk of suicide increased significantly with an O/E ratio of 2.52 and with an excess risk of 2.51 per 10,000 person-years. When the risk of suicide was studied according to the cancer site, the highest increases in the O/E ratio came after diagnoses of pancreatic cancer (8.01) and lung cancer (6.05). The risk of suicide also increased significantly after a diagnosis of colorectal cancer with an O/E ratio of 2.08. However, the risk of suicidal death did not increase significantly after breast and prostate cancer diagnoses. CONCLUSIONS: The risk of suicide increases significantly in the first year after a diagnosis of cancer in comparison with the general population, and this increase varies with the type and prognosis of cancer. Close observation and referral to mental health services, when indicated, are important for mitigating such risk. Cancer 2019;125:972-979.

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“…The National Comprehensive Cancer Network offers distress guidelines and provides a distress thermometer tool to identify at‐risk patients . Among patients with prostate cancer (who are susceptible to developing long‐term depression), screening for depression and erectile dysfunction, in addition to suicidal ideation, has also been suggested . Second, particularly high‐risk groups should be offered counseling or psychiatric referral regardless of suicidal ideation, in addition to smoking‐cessation assistance when necessary.…”

Section: Discussionmentioning

confidence: 99%

“…55 Among patients with prostate cancer (who are susceptible to developing longterm depression 56 ), screening for depression and erectile dysfunction, in addition to suicidal ideation, has also been suggested. 57 Second, particularly high-risk groups should be offered counseling or psychiatric referral regardless of suicidal ideation, in addition to smoking-cessation assistance when necessary. Third, patients with suicidal ideation should maintain a close alliance with their oncology team while also undergoing a complete psychiatric evaluation.…”

Section: Discussionmentioning

confidence: 99%

Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care: A matched‐cohort study of patients with incident solid‐organ malignancies

Klaassen

Wallis

Chandrasekar

et al. 2019

Cancer

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Background Previous studies have demonstrated an association between a diagnosis of cancer and the risk of suicide; however, they failed to account for psychiatric care before a cancer diagnosis, which may confound this relationship. The objective of this study was to assess the effect of a cancer diagnosis on the risk of suicide, accounting for prediagnosis psychiatric care utilization. Methods All adult residents of Ontario, Canada who were diagnosed with cancer (1 of prostate, breast, colorectal, melanoma, lung, bladder, endometrial, thyroid, kidney, or oral cancer) between 1997 and 2014 were identified. Noncancer controls were matched 4:1 based on sociodemographics, including a psychiatric utilization gradient (PUG) score (with 0 indicating none; 1, outpatient; 2, emergency department; and 3, hospital admission). A marginal, cause‐specific hazard model was used to assess the effect of cancer on the risk of suicidal death. Results Among 676,470 patients with cancer and 2,152,682 matched noncancer controls, there were 8.2 and 11.4 suicides per 1000 person‐years of follow‐up, respectively. Patients with cancer had an overall higher risk of suicidal death compared with matched patients without cancer (hazard ratio, 1.34; 95% CI, 1.22‐1.48). This effect was pronounced in the first 50 months after cancer diagnosis (hazard ratio, 1.60; 95% CI, 1.42‐1.81); patients with cancer did not demonstrate an increased risk thereafter. Among individuals with a PUG score 0 or 1, those with cancer were significantly more likely to die of suicide compared with controls. There was no difference in suicide risk between patients with cancer and controls for those who had a PUG score of 2 or 3. Conclusions A cancer diagnosis is associated with increased risk of death from suicide compared with the general population even after accounting for precancer diagnosis psychiatric care utilization. The specific factors underlying the observed associations remain to be elucidated.

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Decreasing suicide risk among patients with prostate cancer: Implications for depression, erectile dysfunction, and suicidal ideation screening

Cited by 53 publications

References 37 publications

Factors contributing to cancer‐related suicide: A study of root‐cause analysis reports

Factors contributing to cancer‐related suicide: A study of root‐cause analysis reports

Suicidal death within a year of a cancer diagnosis: A population‐based study

Cancer diagnosis and risk of suicide after accounting for prediagnosis psychiatric care: A matched‐cohort study of patients with incident solid‐organ malignancies

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