Recognizing Acute Stressors That May Precipitate Suicide in Patients With Metastatic Cancer

Recognition of acute stressors may provide a way of identifying and intervening with patients who have cancer and are at high risk for suicide. Researchers in Hong Kong reported at ESMO Congress 2019 in Barcelona, Spain, that emergency room admissions and bad news disclosure represent acute stressors that may precipitate suicidal attempts in patients with cancer. The researchers reviewed cases of 458 oncology patients who completed suicides and found that in patients with advanced cancer there may be a critical window for suicidal prevention interventions.

The fact that patients with cancer are at higher risk of suicide compared with the general population is well-documented. The researchers examined coroner’s files on all 4613 suicidal deaths in Hong Kong between 2012 and 2016 in an effort to identify potential precipitators to suicide attempts. The files provided considerable insight because they contained detailed reports on demographics, autopsy results, police investigations, and also included a medical summary.

The study showed that 458 of the cases (9.9%) had cancer recorded in their files, and 56% of the cancers were diagnosed as metastatic or incurable disease at the time of suicide. The researchers found that records of emergency room visits, clinic visits, and hospitalizations indicated that patients with metastatic or incurable cancer had significantly higher health resources utilization compared with patients with early-stage cancer.

The study suggested that emergency admissions, which represented symptom crisis, was temporally related to suicide, and time is a factor (90% of suicide episodes occurred within 100 days of emergency admissions). The investigators suspect this may be a significant discovery and theorize that disclosure of bad news may represent another emotional stressor.

In their evaluations of the median time from disclosure of news of metastases to completed suicides, the researchers concluded that emergency admissions and bad news disclosure may represent acute stressors, and a time in which to attempt a suicide prevention intervention.

Reference

Kwan E, TC Lam, Luo H, Yip PS. Emergency admissions and bad news disclosure as precipitators of suicide: a territory-wide cohort analysis of 458 oncology patients who completed suicides. Presented at: ESMO Congress 2019; September 27-October1, 2019; Barcelona, Spain. Abstract 1597PD.