Suicidal behavior in cancer. Part I: epidemiology and risk factors

This article provides an overview of psycho-oncology, including epidemiology of common comorbid psychiatric conditions (i.e., depression, anxiety, delirium) in cancer, and other psychosocial factors associated with a cancer diagnosis and treatment. Cancer patients and survivors have an excess risk for suicidal behavior (can be up to 2 to 10 times as frequent), relative to the general population, which varies with time since first diagnosis, disease severity, anatomical site, and side effects of treatment. Reports identify a higher incidence of suicide in patients with oral, pharyngeal, and lung cancers and in HIV-positive patients with Kaposi sarcoma. The actual incidence of suicide in cancer patients is probably underestimated. Risk factors for suicide in the cancer population are as follows: General Risk Factors. History of psychiatric disorders, especially those associated with impulsive behavior (e.g., borderline personality disorders). Family history of suicide. History of previous/prior suicide attempts. Depression. Substance abuse. Recent death of a friend or spouse. Few social supports. Cancer-Specific Risk Factors. Oral, pharyngeal, and lung cancers (often associated with heavy alcohol and tobacco use). Advanced stage of disease and poor prognosis, onfusion/delirium. Inadequately controlled pain. Presence of deficit symptoms (e.g., loss of mobility, loss of bowel and bladder control, amputation, sensory loss, paraplegia, inability to eat and to swallow, exhaustion, fatigue).