The risk of suicide in cancer patients and some important signs to watch for.
Every year, the 10th of September is observed as World Suicide Prevention Day.
For a serious matter like suicide, are we giving the due importance so that we are able to bring down the number of such incidents every year?- Probably not! On this occasion, I want to take your attention to the risk of suicidal tendencies among cancer patients. I am a psychologist, and I come across many kinds of cancer stories in my career, among them the hardest is when people lose hope and express their wish to end life.
According to studies done among cancer population, the suicide rate is higher (up to 60%) when it compared with the general population or any other medical conditions(Rahouma, 2017). To be able to prevent such cases, it is important for us to create awareness about the various potential areas of risk in a patient’s journey. Past data suggests that the risk of suicide is the highest right after the cancer diagnosis. It is also quite common among the patients in their advanced stage of cancer. The reason for such incidents is often attributed to the ignorance of psychosocial aspects of the disease despite having shown the psychological symptoms. The suicidal ideation, thoughts, and behavior can also be associated with various psychosocial factors such as severe pain, impulsivity, family history, pessimism/hopelessness, lack of emotional support, delirium, feeling of burdening the family or low spirituality. Sometimes, the exacerbation of psychiatric conditions can also bring suicidal ideation among people with cancer.
The rate and number of suicidal attempts are found to be different in different types of cancers. For example, certain cancers like breast, prostate, and head and neck cancers are more associated with higher rates of suicides than other irrespective of the stage of cancer and intent(curative/palliative) of treatment. For instance, the patients who get cancer with the use of tobacco and alcohol turn to consider it as a self-inflicted injury- leading to guilt, shame, and self-blame which may push them into suicidal ideation eventually.
On this occasion, I want to put together some tips that might be helpful for the caregivers and family members who are helping their loved ones during their tough journey and fight against cancer. As I always emphasize, whether suicidal or not, we must not ever ignore the psychological side of the patient when going through the treatment for better results and even better quality of life.
Signs and Symptoms Among Cancer Patients
If you can identify the signs early on, suicide is preventable among cancer patients. One must watch out if patients speak about killing themselves, telling they do not have any reasons to live, or they are worthless and so on and so forth. These are some of the warning signs to look for. Few other signs seen among the patients are a behavior of threatening to kill oneself, browsing on the internet about various ways to die, self-harming, drastic mood swings, and complete social withdrawal symptoms. Additionally, listed below are a few other common contributing factors that may bring suicidal thoughts among cancer patients.
Prior psychiatric history: Studies indicate that a patient who had depression and anxiety are more vulnerable to commit suicide.
Prior suicide attempts: It is considered as a clinically relevant predictor of suicidal behavior. After failed attempts, the risk of repetition of the same behavior is often found in many patients.
Expressing a feeling of burdening the family: When there is less support from family, patients often turn to consider themselves as a burden to their own family. However, in certain cases, even when the family is very supportive the patients take the guilt on themselves for bringing such unexpected emotional and financial disturbances to their loved ones.
Physical symptoms, especially severe pain: As we know, many cancers bring such severe and unimaginable amount of pain to the patients. One needs to be a brave-heart to go through such a tremendous amount of pain.
Preventive Measures and Recommendations
Whether you are a family member or a caretaker, once you have identified the symptoms, you must not waste any time in taking right interventions to help the patient; which means one must immediately inform the primary physician. Getting appropriate help from a Mental Health Professional will be very effective, and it is highly recommended.
Unfortunately in many cases, even identifying the psychological warning signs correctly, and referring the patient to a Mental Health Practitioner at the right time is not yet a norm in many developing countries, including India. As healthcare professionals, below are some of the steps we take, and it is something that must be there in any modern cancer care setting for that matter.
Conclusion
While communicating with cancer patients, always (and always) try to bring positive energy and be very gentle, but surely ASK about their emotional concerns. The biggest mistake often made by many hospitals today is burdening its doctors with a large number of patients, which in turn will be sometimes counterproductive as they cannot obviously find enough time to spend with their patients in understanding their emotional wellbeing. Or sometimes, these duties are offloaded to untrained staff.
Be it a professional or a caregiver, the right way is to actively LISTEN. Listen to the patients without interrupting. Encourage them to express their feelings and open up. It is okay to have long pauses and silence while engaging in a conversation with patients. A psychologist or psycho-oncologist is trained to bring the best out in such cases but it is important to have this awareness spread among the general public.
Lastly, do not leave them alone and tell them that you are always there to help. Ensure the place is safe and they do not have any access or means with which they can aid themselves to take any tragic steps. Spreading awareness is our duty and responsibility because it is something completely preventable if people are more aware of it.
References
Rahouma M, Kamel M, Nasar A, et al. Among all cancers, lung cancer appears to put patients at greatest suicide risk. Am J Respir Crit Care Med. 2017;195.
Aboumrad, M., Shiner, B., Riblet, N., Mills, P. D., & Watts, B. V. (2018). Factors contributing to cancer‐related suicide: A study of root‐cause analysis reports. Psycho‐Oncology.
I’d love to hear your feedback on this post, as well as your experience and other inspiring stories while dealing with cancer care. (If you are a cancer care professional and looking for a chance to connect, share and discuss your passion with other like-minded people, come join us on Psycho-oncology Professional Network)
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