Citation

Gage-Bouchard EA, Pailler M, Devine KA, Flores T. J. Natl. Cancer Inst. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Oxford University Press)

DOI

10.1093/jnci/djaa185

PMID

unavailable

Abstract

In recent decades, substantial advances in cancer treatment and early detection have resulted in enhanced survival among cancer patients. Such advances have elevated the importance of understanding and addressing patient-centered needs related to physical, psychological, and social well-being (1,2). In this issue of the Journal, Han et al. (3) analyzed data from the Multiple Causes of Death database to examine trends in cancer-related suicide from 1999 to 2018. They found that in contrast to rising rates of suicide in the United States, suicide rates have decreased among cancer patients over the last 20 years. Although this decline in suicide rate is encouraging, rates of suicide among cancer patients continue to be higher than the general population (4), highlighting cancer patients as an at-risk group for suicide. The study by Han et al. (3) is an important step in understanding overall suicide trends among cancer patients and sets the stage for further investigation into mechanisms underlying this observed decline. The authors hypothesize that increased access to psychosocial, palliative, and hospice care plays an important role in contributing to the decline in suicide among cancer patients. This is a sound hypothesis and highlights the need to understand more about factors that heighten risk for suicide among cancer patients as well as components of health services--such as psychosocial oncology, palliative, and hospice care--that are most critical in lowering suicide risk among cancer patients. An evidence-based approach to understanding what is working, and for whom, is needed to further accelerate the decline in suicide among cancer patients.

For many patients, a cancer diagnosis and treatment represents a major disruption to their abilities to engage in daily activities, paid work, and their family, friend, and religious communities. Cancer patients can experience a lack of social support, social isolation, and loneliness (5). Many patients also experience cancer-related financial hardship related to high medical bills, work disruptions, depletion of assets, or increased debt (6). For example, recent attention to financial toxicity associated with cancer has highlighted the high rates of bankruptcy among cancer patients (7). Cancer patients experience depression at higher rates than the general population (8) and report high levels of sleep disturbance (8), posttraumatic stress (9), anxiety, fear, and worry (10). Importantly, these negative experiences can get carried into survivorship. As Han et al. (3) noted, pediatric cancer survivors are at increased risk of suicide decades after their treatment has ended (11). This highlights the importance of psychosocial services throughout the cancer trajectory.

In addition to measures of quality of life and psychological well-being, patients' psychological experiences are linked to important healthcare delivery outcomes. For example, depression is a robust predictor of treatment adherence and increased use of emergency and inpatient medical services...

Language: en