Suicide in Patients With Cancer: Identifying the Risk Factors.

Thoughts of suicide while dealing with cancer are exceedingly common, though relatively few patients make a suicide attempt or complete suicide. Suicide rates among cancer patients are generally thought to be twice as high as that of the general population. However, patients with certain cancer types are at much higher risk for suicide; patients may also be more at risk at certain times during their cancer trajectory. While it is not possible to predict a suicidal act, key features identify those who should be screened more closely. Depression, psychiatric history, previous suicide attempts, hopelessness, demoralization, pain, lack of social support, feeling like a burden to others, and existential concerns (regret, loss of meaning, purpose, and dignity), along with specific demographic characteristics and cancer types confer increased suicidality. Oncologists play a crucial role in identifying these high-risk patients. The Columbia-Suicide Severity Rating Scale is a well-established screening instrument that staff members can use to assess suicidal thinking in patients.

A comprehensive review of palliative care in patients with cancer.

One of the most challenging roles for the psychiatrist is to help guide terminally ill patients physically, psychologically and spiritually through the dying process. Patients with advanced cancer, and other life-threatening medical illnesses are at increased risk for developing major psychiatric complications and have an enormous burden of both physical as well as psychological symptoms. In fact, surveys suggest that psychological symptoms such as depression, anxiety, and hopelessness are as frequent, if not more so, than pain and other physical symptoms in palliative care settings. Psychiatrists have a unique role and opportunity to offer competent and compassionate palliative care to those with life-threatening illness. In this article we provide a comprehensive review of basic concepts and definitions of palliative care and the experience of dying, and the role of the psychiatrist in palliative care including assessment and management of common psychiatric disorders in the terminally ill, with an emphasis on suicide and desire for hastened death. Psychotherapies developed for use in palliative care settings, and management of grief and bereavement are also reviewed.