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What Do I Say? Suicide Assessment and Management

Liz Cooke
Jennifer Gotto
Lina Mayorga
Marcia Grant
Rachel Lynn
CJON 2013, 17(1), E1-E7 DOI: 10.1188/13.CJON.E1-E7

The risk of suicide in the cancer population is real, and it requires nurses to be able to assess and manage such risk competently. This article supports the idea that oncology nurses need to be comfortable with identifying, assessing, and appropriately triaging depressed and possibly suicidal patients with cancer to appropriate specialists, given the increased risk of suicidal ideation and completion in the cancer population. The goal of this article is to help oncology nurses identify the specific risk factors for suicide in their patients with cancer, feel confident and prepared with an accurate assessment, and provide the necessary interventions.


Adler, N. E., & Page, A. E. (Eds.). (2008). <i>Cancer care for the whole patient: Meeting psychosocial health needs.</i> Washington, DC: National Academies Press.

Ahn, E., Shin, D. W., Cho, S. I., Park, S., Won, Y. J., & Yun, Y. H. (2010). Suicide rates and risk factors among Korean cancer patients, 1993-2005. <i>Cancer Epidemiology, Biomarkers and Prevention, 19</i>, 2097-2105. doi:10.1158/1055-9965.epi-10-0261

Akechi, T., Nakano, T., Akizuki, N., Nakanishi, T., Yoshikawa, E., Okamura, H., & Uchitomi, Y. (2002). Clinical factors associated with suicidality in cancer patients. <i>Japanese Journal of Clinical Oncology, 32</i>, 506-511. doi:10.1093/jjco/hyf106

Akechi, T., Okamura, H., Nakano, T., Akizuki, N., Okamura, M., Shimizu, K., … Uchitomi, Y. (2010). Gender differences in factors associated with suicidal ideation in major depression among cancer patients. <i>Psycho-Oncology, 19</i>, 384-389. doi:10.1002/pon.1587

Akizuki, N., Yamawaki, S., Akechi, T., Nakano, T., & Uchitomi, Y. (2005). Development of an Impact Thermometer for use in combination with the Distress Thermometer as a brief screening tool for adjustment disorders and/or major depression in cancer patients. <i>Journal of Pain and Symptom Management, 29</i>, 91-99. doi:10.1016/j.jpainsymman.2004.04.016

Ballard, E. D., Pao, M., Henderson, D., Lee, L. M., Bostwick, J. M., & Rosenstein, D. L. (2008). Suicide in the medical setting. <i>Joint Commission Journal on Quality and Patient Safety, 34</i>, 474-481.

Bill-Axelson, A., Garmo, H., Lambe, M., Bratt, O., Adolfsson, J., Nyberg, U., … Stattin, P. (2010). Suicide risk in men with prostate-specific antigen-detected early prostate cancer: A nationwide population-based cohort study from PCBaSe Sweden. <i>European Urology, 57</i>, 390-395. doi:10.1016/j.eururo.2009.10.035

Birkholz, G., Gibson, J. M., & Clements, P. T. (2004). Dying patients' thoughts of ending their lives: A pilot study of rural New Mexico. <i>Journal of Psychosocial Nursing and Mental Health Services, 42</i>(8), 34-44.

Breitbart, W., Rosenfeld, B., Pessin, H., Kaim, M., Funesti-Esch, J., Galietta, M., … Brescia, R. (2000). Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. <i>JAMA, 284</i>, 2907-2911. doi:10.1001/jama.284.22.2907

Breitbart, W. S., & Alici, Y. (2009). Psycho-oncology. <i>Harvard Review of Psychiatry, 17</i>, 361-376. doi:10.3109/10673220903465700

Carlson, R. H. (2010). Helping prevent suicide in cancer patients: Those thinking of it won't tell unless you ask. <i>Oncology Times, 32</i>(18), 15-19. doi:10.1097/01.COT.0000389877.67594.b8

Centers for Disease Control and Prevention. (2012). Injury prevention and control: Data and statistics (WISQARS™). Retrieved from <a target="_blank" href='http://www.cdc.gov/injury/wisqars/index.html'>http://www.cdc.gov/injury/...

Dabrowski, M., Boucher, K., Ward, J. H., Lovell, M. M., Sandre, A., Bloch, J., … Buys, S. S. (2007). Clinical experience with the NCCN Distress Thermometer in breast cancer patients. <i>Journal of the National Comprehensive Cancer Network, 5</i>(1), 104-111.

Emanuel, E. J., Fairclough, D. L., & Emanuel, L. L. (2000). Attitudes and desires related to euthanasia and physician-assisted suicide among terminally ill patients and their caregivers. <i>JAMA, 284</i>, 2460-2468. doi:10.1001/jama.284.19.2460

Fallowfield, L., Ratcliffe, D., Jenkins, V., & Saul, J. (2001). Psychiatric morbidity and its recognition by doctors in patients with cancer. <i>British Journal of Cancer, 84</i>, 1011-1015. doi:10.1054/bjoc.2001.1724

Filiberti, A., & Ripamonti, C. (2002). Suicide and suicidal thoughts in cancer patients. <i>Tumori, 88</i>, 193-199.

Fishbain, D. A. (1999). The association of chronic pain and suicide. <i>Seminars in Clinical Neuropsychiatry, 4</i>, 221-227.

Ganzini, L., Harvath, T. A., Jackson, A., Goy, E. R., Miller, L. L., & Delorit, M. A. (2002). Experiences of Oregon nurses and social workers with hospice patients who requested assistance with suicide. <i>New England Journal of Medicine, 347</i>, 582-588. doi:10.1056/NEJMsa020562

Gessler, S., Low, J., Daniells, E., Williams, R., Brough, V., Tookman, A., & Jones, L. (2008). Screening for distress in cancer patients: Is the distress thermometer a valid measure in the UK and does it measure change over time? A prospective validation study. <i>Psycho-Oncology, 17</i>, 538-547. doi:10.1002/pon.1273

Güth, U., Myrick, M. E., Reisch, T., Bosshard, G., & Schmid, S. M. (2011). Suicide in breast cancer patients: An individual-centered approach provides insight beyond epidemiology. <i>Acta Oncologica, 50</i>, 1037-1044. doi:10.3109/0284186X.2011.602112

Hirschfeld, R. M., & Russell, J. M. (1997). Assessment and treatment of suicidal patients. <i>New England Journal of Medicine, 337</i>, 910-915. doi:10.1056/NEJM199709253371307

Jacobsen, P. B., Donovan, K. A., Trask, P. C., Fleishman, S. B., Zabora, J., Baker, F., & Holland, J. C. (2005). Screening for psychologic distress in ambulatory cancer patients. <i>Cancer, 103</i>, 1494-1502. doi:10.1002/cncr.20940

Johansen, S., Hølen, J. C., Kaasa, S., Loge, H. J., & Materstvedt, L. J. (2005). Attitudes towards, and wishes for, euthanasia in advanced cancer patients at a palliative medicine unit. <i>Palliative Medicine, 19</i>, 454-460. doi:10.1191/0269216305pm1048oa

Johnson, T. V., Garlow, S. J., Brawley, O. W., & Master, V. A. (2012). Peak window of suicides occurs within the first month of diagnosis: Implications for clinical oncology. <i>Psycho-Oncology, 21</i>, 351-356. doi:10.1002/pon.1905

Joiner, T. E., Jr. (2002). The trajectory of suicidal behavior over time. <i>Suicide and Life-Threatening Behavior, 32</i>(1), 33-41. doi:10.1521/suli.

Kochanek, K. D., Xu, J., Murphy, S. K., Minino, A. M., & Kung, H. (2011). Deaths: Preliminary data for 2009. <i>National Vital Statistics Reports, 59</i>(4), 1-117.

Logan, J., Hall, J., & Karch, D. (2011). Suicide categories by patterns of known risk factors: A latent class analysis. <i>Archives of General Psychiatry, 68</i>, 935-941. doi:10.1001/archgenpsychiatry.2011.85

Lydiatt, W. M., Denman, D., McNeilly, D. P., Puumula, S. E., & Burke, W. J. (2008). A randomized, placebo-controlled trial of citalopram for the prevention of major depression during treatment for head and neck cancer. <i>Archives of Otolaryngology—Head and Neck Surgery, 134</i>, 528-535. doi:10.1001/archotol.134.5.528

Lynn, R., Gotto, J., Cooke, L., Mayorga, L., & Grant, M. (2012). <i>Outpatient psychiatric consulations at an NCI-designated cancer center: A retrospective chart review.</i> Paper presented at the Academy of Psychosomatic Medicine, Atlanta, GA.

Mahdi, H., Swensen, R. E., Munkarah, A. R., Chiang, S., Luhrs, K., Lockhart, D., & Kumar, S. (2011). Suicide in women with gynecologic cancer. <i>Gynecologic Oncology, 122</i>, 344-349. doi:10.1016/j.ygyno.2011.04.015

Maniglio, R. (2011). The role of child sexual abuse in the etiology of suicide and nonsuicidal self-injury. <i>Acta Psychiatrica Scandinavica, 124</i>(1), 30-41. doi:10.1111/j.1600-0447.2010.01612.x

Meyer, R. E., Salzman, C., Youngstrom, E. A., Clayton, P. J., Goodwin, F. K., Mann, J. J., … Sheehan, D. V. (2010). Suicidality and risk of suicide—Definition, drug safety concerns, and a necessary target for drug development: A consensus statement. <i>Journal of Clinical Psychiatry, 71</i>(8), e1-e21. doi:10.4088/JCP.10cs06070blu

Miller, M., Mogun, H., Azrael, D., Hempstead, K., & Solomon, D. H. (2008). Cancer and the risk of suicide in older Americans. <i>Journal of Clinical Oncology, 26</i>, 4720-4724. doi:10.1200/JCO.2007.14.3990

Misono, S., Weiss, N. S., Fann, J. R., Redman, M., & Yueh, B. (2008). Incidence of suicide in persons with cancer. <i>Journal of Clinical Oncology, 26</i>, 4731-4738. doi:10.1200/JCO.2007.13.8941

Mitchell, A. J. (2007). Pooled results from 38 analyses of the accuracy of Distress Thermometer and other ultra-short methods of detecting cancer-related mood disorders. <i>Journal of Clinical Oncology, 25</i>, 4670-4681. doi:10.1200/JCO.2006.10.0438

National Comprehensive Cancer Network. (2005). The National Comprehensive Cancer Network 1.2005 distress management. The complete library of NCCN Clinical Practice Guidelines in Oncology [CD-ROM]. Fort Washington, PA: Author.

Nicholas, D. R., & Veach, T. A. (2000). The psychosocial assessment of the adult cancer patient. <i>Professional Psychology: Research and Practice, 31</i>, 206-215. doi:10.1037/0735-7028.31.2.206

Nissim, R., Gagliese, L., & Rodin, G. (2009). The desire for hastened death in individuals with advanced cancer: A longitudinal qualitative study. <i>Social Science and Medicine, 69</i>, 165-171. doi:10.1016/j.socscimed.2009.04.021

Paulozzi, L. J., Mercy, J., Frazier, L., Jr., & Annest, J. L. (2004). CDC's National Violent Death Reporting System: Background and methodology. <i>Injury Prevention, 10</i>(1), 47-52. doi:10.1136/ip.2003.003434

Quill, T. E. (2008). Suicidal thoughts and actions in cancer patients: The time for exploration is now. <i>Journal of Clinical Oncology, 26</i>, 4705-4707. doi:10.1200/JCO.2008.18.3129

Ransom, S., Jacobsen, P. B., & Booth-Jones, M. (2006). Validation of the Distress Thermometer with bone marrow transplant patients. <i>Psycho-Oncology, 15</i>, 604-612. doi:10.1002/pon.993

Rasic, D. T., Belik, S. L., Bolton, J. M., Chochinov, H. M., & Sareen, J. (2008). Cancer, mental disorders, suicidal ideation and attempts in a large community sample. <i>Psycho-Oncology, 17</i>, 660-667. doi:10.1002/pon.1292

Recklitis, C. J., Diller, L. R., Li, X., Najita, J., Robison, L. L., & Zeltzer, L. (2010). Suicide ideation in adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. <i>Journal of Clinical Oncology, 28</i>, 655-661. doi:10.1200/JCO.2009.22.8635

Robinson, D., Renshaw, C., Okello, C., Møller, H., & Davies, E. A. (2009). Suicide in cancer patients in South East England from 1996 to 2005: A population-based study. <i>British Journal of Cancer, 101</i>(1), 198-201. doi:10.1038/sj.bjc.6605110

Robson, A., Scrutton, F., Wilkinson, L., & MacLeod, F. (2010). The risk of suicide in cancer patients: A review of the literature. <i>Psycho-Oncology, 19</i>, 1250-1258. doi:10.1002/pon.1717

Rosenfeld, B. (2000). Assisted suicide, depression, and the right to die. <i>Psychology, Public Policy, and the Law, 6</i>, 467-488. doi:10.1037/1076-8971.6.2.467

Rosenfeld, B., & Breitbart, W. (2000). Physician-assisted suicide and euthanasia. <i>New England Journal of Medicine, 343</i>, 151-153.

Rosenstein, D. L. (2011). Depression and end-of-life care for patients with cancer. <i>Dialogues in Clinical Neuroscience, 13</i>(1), 101-108.

Sciubba, J. J. (2009). End-of-life considerations in the head and neck cancer patient. <i>Oral Oncology, 45</i>(4-5), 431-434. doi:10.1016/j.oraloncology.2008.06.001

Shim, E. J., & Hahm, B. J. (2011). Anxiety, helplessness/hopelessness and "desire for hastened death" in Korean cancer patients. <i>European Journal of Cancer Care, 20</i>, 395-402. doi:10.1111/j.1365-2354.2010.01202.x

Spijker, J., de Graaf, R., Ten Have, M., Nolen, W. A., & Speckens, A. (2010). Predictors of suicidality in depressive spectrum disorders in the general population: Results of the Netherlands Mental Health Survey and Incidence Study. <i>Social Psychiatry and Psychiatric Epidemiology, 45</i>, 513-521. doi:10.1007/s00127-009-0093-6

Spoletini, I., Gianni, W., Caltagirone, C., Madaio, R., Repetto, L., & Spalletta, G. (2011). Suicide and cancer: Where do we go from here? <i>Critical Review of Oncologic Hematology, 78</i>, 206-219. doi:10.1016/j.critrevonc.2010.05.005

Steinhauser, K. E., Clipp, E. C., McNeilly, M., Christakis, N. A., McIntyre, L. M., & Tulsky, J. A. (2000). In search of a good death: Observations of patients, families, and providers. <i>Annals of Internal Medicine, 132</i>, 825-832.

Suarez-Almazor, M. E., Newman, C., Hanson, J., & Bruera, E. (2002). Attitudes of terminally ill cancer patients about euthanasia and assisted suicide: Predominance of psychosocial determinants and beliefs over symptom distress and subsequent survival. <i>Journal of Clinical Oncology, 20</i>, 2134-2141. doi:10.1200/JCO.2002.08.023

Tang, N. K., & Crane, C. (2006). Suicidality in chronic pain: A review of the prevalence, risk factors and psychological links. <i>Psychological Medicine, 36</i>, 575-586. doi:10.1017/S0033291705006859

Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., … Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. <i>New England Journal of Medicine, 363</i>, 733-742. doi:10.1056/NEJMoa1000678

Turaga, K. K., Malafa, M. P., Jacobsen, P. B., Schell, M. J., & Sarr, M. G. (2011). Suicide in patients with pancreatic cancer. <i>Cancer, 117</i>, 642-647. doi:10.1002/cncr.25428

Valente, S. M. (2010). Oncology nurses' knowledge of suicide evaluation and prevention. <i>Cancer Nursing, 33</i>, 290-295. doi:10.1097/NCC.0b013e3181cc4f33

van der Lee, M. L., van der Bom, J. G., Swarte, N. B., Heintz, A. P., de Graeff, A., & van den Bout, J. (2005). Euthanasia and depression: A prospective cohort study among terminally ill cancer patients. <i>Journal of Clinical Oncology, 23</i>, 6607-6612. doi:10.1200/JCO.2005.14.308

Walker, J., Waters, R. A., Murray, G., Swanson, H., Hibberd, C. J., Rush, R. W., … Sharpe, M. (2008). Better off dead: Suicidal thoughts in cancer patients. <i>Journal of Clinical Oncology, 26</i>, 4725-4730. doi:10.1200/JCO.2007.11.8844

World Health Organization. (2012). Mental health: Suicide prevention (SUPRE). Retrieved from <a target="_blank" href='http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/'>...