Suicide in cancer patients undergoing palliative care: A report of two cases
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Abstract
Objective. This study sought to report the cases of suicide in patients with cancer undergoing palliative care at a large cancer reference center.
Method. A retrospective review of records was performed between 2018-2019 for patients treated at the Palliative Care Service of the Instituto Nacional de Cancerología in Mexico City. Records for patients who committed suicide were reviewed to describe factors associated with this outcome.
Results. Among all deaths identified during the record review, two were due to suicide (.09%). The patients were one female and one male, 60 and 42 years of age, diagnosed with breast cancer and gastroesophageal junction cancer, respectively, associated with tobacco and alcohol consumption, as well as several economic, social, and familial stress factors. One of the patients was identified as likely having major depressive disorder.
Discussion and conclusion. Deaths might be underreported in our population. A systematic evaluation is required in order to establish and detect suicidal behavior risk factors, and a follow-up plan for all these patients.
References
Allende-Pérez, S., Verástegui-Avilés, E., Chavira-Estefan, S., Tejeida-Bautista, L., & Domínguez-Ocadio, G. (2013). ¿Cuándo referir a un paciente con cáncer a cuidados paliativos? Gaceta Mexicana de Oncología, 12(4), 280-285.
Amiri, S., & Behnezhad, S. (2019). Cancer Diagnosis and Suicide Mortality: A Systematic Review and Meta-Analysis. Archives of Suicide Research, 24(sup2), S94-S112. doi: 10.1080/13811118.2019.1596182
Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2), 343-352. doi: 10.1037//0022-006x.47.2.343
Bellido-Pérez, M., Crespo, I., Wilson, K. G., Porta-Sales, J., Balaguer, A., & Monforte-Royo, C. (2018). Assessment of the wish to hasten death in patients with advanced cancer: A comparison of 2 different approaches. Psycho-Oncology, 27(6), 1538-1544. doi: 10.1002/pon.4689
Borges, G., Orozco, R., Benjet, C., & Medina-Mora, M. E. (2010). [Suicide and suicidal behaviors in Mexico: Retrospective and current status]. Salud Pública México, 52(4), 292-304.
Carreira, H., Williams, R., Müller, M., Harewood, R., Stanway, S., & Bhaskaran, K. (2018). Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review. Journal of the National Cancer Institute, 110(12), 1311-1327. doi: 10.1093/jnci/djy177
Choi, J. W., & Park, E.-C. (2020). Suicide risk after cancer diagnosis among older adults: A nationwide retrospective cohort study. Journal of Geriatric Oncology, 11(5), 814-819. doi: 10.1016/j.jgo.2019.11.006
Choy, C. H.-L. (2017). Suicide in palliative care setting. Annals of Palliative Medicine, 6(Suppl 2), S264-S265. doi: 10.21037/apm.2017.07.02
Departamento de Bioestadística. (2020). Información estadística. Instituto Nacional de Cancerología.
Du, L., Shi, H.-Y., Yu, H.-R., Liu, X.-M., Jin, X.-H., Yan-Qian, … Chen, H.-L. (2020). Incidence of suicide death in patients with cancer: A systematic review and meta-analysis. Journal of Affective Disorders, 276, 711-719. doi: 10.1016/j.jad.2020.07.082
Fan, W., Yang, H., Sun, Y., Zhang, J., Li, G., Zheng, Y., & Liu, Y. (2017). Ketamine rapidly relieves acute suicidal ideation in cancer patients: A randomized controlled clinical trial. Oncotarget, 8(2), 2356-2360. doi: 10.18632/oncotarget.13743
Fernández-Niño, J. A., Astudillo-García, C. I., Bojorquez-Chapela, I., Morales-Carmona, E., Montoya-Rodriguez, A. A., & Palacio-Mejia, L. S. (2016). The Mexican Cycle of Suicide: A National Analysis of Seasonality, 2000-2013. PLOS ONE, 11(1), e0146495. doi: 10.1371/journal.pone.0146495
Filiberti, A., Ripamonti, C., Totis, A., Ventafridda, V., De Conno, F., Contiero, P., & Tamburini, M. (2001). Characteristics of Terminal Cancer Patients Who Committed Suicide During a Home Palliative Care Program. Journal of Pain and Symptom Management, 22(1), 544-553. doi: 10.1016/S0885-3924(01)00295-0
Grunebaum, M. F., Galfalvy, H. C., Choo, T.-H., Keilp, J. G., Moitra, V. K., Parris, M. S., … Mann, J. J. (2018). Ketamine for Rapid Reduction of Suicidal Thoughts in Major Depression: A Midazolam-Controlled Randomized Clinical Trial. American Journal of Psychiatry, 175(4), 327-335. doi: 10.1176/appi.ajp.2017.17060647
Grzybowska, P., & Finlay, I. (1997). The incidence of suicide in palliative care patients. Palliative Medicine, 11(4), 313-316. doi: 10.1177/026921639701100408
Gutiérrez-García, A. G., Contreras, C. M., & Orozco-Rodríguez, R. C. (2006). El suicidio, conceptos actuales. Salud Mental, 29(5), 66-74.
Henson, K. E., Brock, R., Charnock, J., Wickramasinghe, B., Will, O., & Pitman, A. (2019). Risk of Suicide After Cancer Diagnosis in England. JAMA Psychiatry, 76(1), 51-60. doi: 10.1001/jamapsychiatry.2018.3181
Hinrichs, K. L. M., Steadman-Wood, P., & Meyerson, J. L. (2020). ACT Now: The Intersection of Acceptance and Commitment Therapy with Palliative Care in a Veteran with Chronic Suicidal Ideation. Clinical Gerontologist, 43(1), 126-131. doi: 10.1080/07317115.2019.1642974
Hopko, D. R., Armento, M. E. A., Robertson, S. M. C., Ryba, M. M., Carvalho, J. P., Colman, L. K., … Lejuez, C. W. (2011). Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: Randomized trial. Journal of Consulting and Clinical Psychology, 79(6), 834-849. doi: 10.1037/a0025450
Hopko, D. R., Funderburk, J. S., Shorey, R. C., McIndoo, C. C., Ryba, M. M., File, A. A., … Vitulano, M. (2013). Behavioral Activation and Problem-Solving Therapy for Depressed Breast Cancer Patients: Preliminary Support for Decreased Suicidal Ideation. Behavior Modification, 37(6), 747-767. doi: 10.1177/0145445513501512
Kawashima, Y., Yonemoto, N., Inagaki, M., Inoue, K., Kawanishi, C., & Yamada, M. (2019). Interventions to prevent suicidal behavior and ideation for patients with cancer: A systematic review. General Hospital Psychiatry, 60, 98-110. doi: 10.1016/j.genhosppsych.2019.07.003
Keaton, S. A., Madaj, Z. B., Heilman, P., Smart, L., Grit, J., Gibbons, R., … Brundin, L. (2019). An inflammatory profile linked to increased suicide risk. Journal of Affective Disorders, 247, 57-65. doi: 10.1016/j.jad.2018.12.100
Kolva, E., Hoffecker, L., & Cox-Martin, E. (2020). Suicidal ideation in patients with cancer: A systematic review of prevalence, risk factors, intervention and assessment. Palliative & Supportive Care, 18(2), 206-219. doi: 10.1017/S1478951519000610
Kumar, V., Chaudhary, N., Soni, P., & Jha, P. (2017). Suicide Rates in Cancer Patients in the Current Era in United States. American Journal of Psychiatry Residents’ Journal, 12(1), 11-14. doi: 10.1176/appi.ajp-rj.2017.120104
Lee, Y. J., Kim, C.-M., Linton, J. A., Lee, D. C., Suh, S.-Y., Seo, A.-R., & Ahn, H.-Y. (2013). Association between Spiritual Well-Being and Pain, Anxiety and Depression in Terminal Cancer Patients: A Pilot Study. The Korean Journal of Hospice and Palliative Care, 16(3), 175-182. doi: 10.14475/kjhpc.2013.16.3.175
Mondragón, L., Saltijeral, M. T., Bimbela, A., & Borges, G. (1998). La ideación suicida y su relación con la desesperanza, el abuso de drogas y alcohol. Salud Mental, 21(5), 20-27.
Monforte-Royo, C., González-de Paz, L., Tomás-Sábado, J., Rosenfeld, B., Strupp, J., Voltz, R., & Balaguer, A. (2017). Development of a short form of the Spanish schedule of attitudes toward hastened death in a palliative care population. Quality of Life Research, 26(1), 235-239. doi: 10.1007/s11136-016-1409-0
Oken, M. M., Creech, R. H., Tormey, D. C., Horton, J., Davis, T. E., McFadden, E. T., & Carbone, P. P. (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology, 5(6), 649-655.
O’Connor, M., Groom, J., Watson, M., & Harris, P. (2016). Developing Organizational Guidelines for the Prevention and Management of Suicide in Clients and Carers Receiving Palliative Care in Australia. American Journal of Hospice and Palliative Medicine, 33(3), 252-255. doi: 10.1177/1049909114565659
Rodríguez-Mayoral, O., Ascencio-Huertas, L., Verástegui, E., Delgado-Guay, M. O., & Allende-Pérez, S. (2019a). The desire to hasten death in advanced cancer patients at a Mexican palliative care service. Salud Mental, 42(3), 103-109. doi: 10.17711/SM.0185-3325.2019.014
Rodríguez-Mayoral, O., Pérez-Esparza, R., Domínguez-Ocadio, G., & Allende-Pérez, S. (2020). Ketamine as augmentation for the treatment of major depression and suicidal risk in advanced cancer: Case report. Palliative & Supportive Care, 18(1), 110-112. doi: 10.1017/S1478951519000580
Rodríguez-Mayoral, O., Rodríguez-Ortíz, B., Ascencio-Huertas, L., Peña-Nieves, A., Verástegui, E., Allende-Pérez, S., & Lloyd-Williams, M. (2019b). Validation of the Brief Edinburgh Depression Scale (BEDS) in a Mexican population with advanced cancer in a palliative care service. Palliative & Supportive Care, 17(4), 436-440. doi: 10.1017/S1478951518000640
Saxena, S., Krug, E. G., Chestnov, O., & World Health Organization, Eds. (2014). Preventing suicide: A global imperative. Geneva: World Health Organization.
Sullivan, D. R., Forsberg, C. W., Golden, S. E., Ganzini, L., Dobscha, S. K., & Slatore, C. G. (2018). Incidence of Suicide and Association with Palliative Care among Patients with Advanced Lung Cancer. Annals of the American Thoracic Society, 15(11), 1357-1359. doi: 10.1513/AnnalsATS.201805-299RL
Thekkumpurath, P., Walker, J., Butcher, I., Hodges, L., Kleiboer, A., O’Connor, M., … Sharpe, M. (2011). Screening for major depression in cancer outpatients: The diagnostic accuracy of the 9-item patient health questionnaire. Cancer, 117(1), 218-227. doi: 10.1002/cncr.25514
Zaorsky, N. G., Zhang, Y., Tuanquin, L., Bluethmann, S. M., Park, H. S., & Chinchilli, V. M. (2019). Suicide among cancer patients. Nature Communications, 10(1), 207. doi: 10.1038/s41467-018-08170-1
Zhang, Y., Law, C. K., & Yip, P. S. F. (2011). Psychological factors associated with the incidence and persistence of suicidal ideation. Journal of Affective Disorders, 133(3), 584-590. doi: 10.1016/j.jad.2011.05.003
