Patient‐oncologist alliance as protection against suicidal ideation in young adults with advanced cancer

Abstract

Background Young adults with cancer are at increased risk for suicidal ideation. The impact of the patient-oncologist alliance on suicidal ideation has not been examined. This study examined the relationship between the patient-oncologist therapeutic alliance and suicidal ideation in young adults with advanced cancer. Methods Young adult patients (age 20-40 years; n=93) with incurable, recurrent, or metastatic cancer were evaluated by trained interviewers. Suicidal ideation was assessed with the Yale Evaluation of Suicidality, dichotomized into a positive and negative score. Predictors included diagnoses of Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD), physical quality of life, social support, and utilization of mental health and supportive care services. The Human Connection Scale, dichotomized into strong (upper third) and weak (lower two-thirds) therapeutic alliance assessed strength of the patients’ perceived oncologist alliance. Results 22.6% screened positive for suicidal ideation. Patients with a strong therapeutic alliance were at reduced risk for suicidal ideation after controlling for confounding influences of cancer diagnosis, performance status, number of physical symptoms, physical quality of life, MDD, PTSD, and social support. A strong therapeutic alliance was also associated with reduced risk for suicidal ideation after controlling for mental health discussions with healthcare providers and use of mental health interventions. Conclusions The patient-oncologist alliance was a robust predictor of suicidal ideation and provided better protection against suicidal ideation than mental health interventions, including psychotropic medications. Oncologists may significantly influence patients’ mental health and may benefit from training and guidance in building strong alliances with their young adult patients.

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A qualitative study of sexual and reproductive health communication with adolescent and young adult oncology patients

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End-of-Life Care Intensity Among Adolescent and Young Adult Patients With Cancer in Kaiser Permanente Southern California

“…[1–4] Yet we know very little about the end-of-life care that these young patients receive. Existing work has focused on the development of tools for end-of-life care planning,[5, 6] on psychological distress,[7–9] and on understanding adolescent patients’ wishes as they make cancer treatment decisions. [10] In addition, a single-center study in France evaluated care among 45 AYA cancer decedents and found high rates of symptoms and aggressive measures.…”