Palliative and Supportive Care cambridge.org/pax Editorial Cite this article: Davidson C, Desbeaumes Jodoin V, Aubin F, Levenson JA, Rivest J (2021). Suicide prevention in cancer care: What are the next steps? Palliative and Supportive Care 19, 394–396. https://doi.org/10.1017/ S1478951521000912 Received: 3 May 2021 Accepted: 30 May 2021 Author for correspondence: Jacynthe Rivest, 1000 St-Denis, Montreal, Quebec, Canada. E-mail: jacynthe.rivest@umontreal.ca © The Author(s), 2021. Published by Cambridge University Press Suicide prevention in cancer care: What are the next steps? Claudine Davidson, M.D. 1 , Véronique Desbeaumes Jodoin, PH.D. 2 , Francine Aubin, M.D. 3 , Jon A. Levenson, M.D. 4 and Jacynthe Rivest, M.D., M.A. 2 1 Psychiatry Residency Program, University of Ottawa, Ottawa, Ontario, Canada; 2 Department of Psychiatry, CHUM, and Psychosocial Oncology Research Team, CRCHUM, Montreal, Quebec, Canada; 3 Hemato-oncology Service, Department of Medicine, CHUM and CRCHUM, Montreal, Quebec, Canada and 4 Columbia University Irving Medical Center, New York, NY Introduction Living with cancer can be challenging. Recent studies estimate that 40% of cancer patients will experience significant distress during their illness trajectory. Persistent distress is associated with the dissatisfaction of care, lower quality of life, and psychiatric disorders. Some patients will also present an increased risk of wishes to hasten death, suicidal ideations, or completed sui- cide compared with the general population (McFarland et al., 2019). Though suicide is recognized as a global public health problem, suicide prevention in cancer care has not garnered the same attention (Turecki et al., 2019). Current guidelines promoting systematic screening for distress only recommend suicide risk assessment when anxiety or depression symptoms are detected. Although speculative, this potential risk begs the question of which the next steps should be con- sidered for suicide prevention for this specific high-risk population. The COVID-19 pandemic has led mental health experts to anticipate an increase in distress and suicide risk among the general population (Gunnell et al., 2020). For cancer patients, the pandemic brings forward significant new challenges, such as difficulty or inability to access cancer treatments, strict isolation measures which limit their social support and of course fear of contamination which is associated with higher mortality and morbidity in cancer patients. Little is known of the impact, this pandemic will have on distress or the prevalence of mental illness, and of suicide in cancer patients. Suicide risk in patients with cancer: should we be more vigilant? Despite the high prevalence of distress and comorbid mental illnesses, depression and anxiety remain underdiagnosed and undertreated in cancer patients. Existing data showed that depres- sive symptoms, especially when severe, are associated with poor quality of life, a feeling of hopelessness and can be associated with suicidal ideation, leading to a higher risk of attempted or completed suicide compared with the general population. Cancer patients who experience intolerable suffering may express a wish to hasten death (WTHD) or request physician-assisted death if accessible. WTHD is conceptualized as a desire for death before its natural occurrence and is considered a response to unrelieved suffering. When such desire is expressed, medical teams are left with the responsibility of assessing the patient’s state and ensuring access to appropriate care. Depression has been found to be an important predictor of both WTHD and suicidal ideation among cancer patients. Psychiatric disorders are frequently found among patients who request physician-assisted death, especially at advanced stages (Canadian Association of Psychosocial Oncology (CAPO), 2017). For those who are not deemed candidates, the refusal may also lead to abstain- ing from eating or drinking, a suicide attempt, or threatening their medical team of such behaviors if they do not obtain physician-assisted death (Isenberg-Grzeda et al., 2020). Although it remains a rare phenomenon, it is more prevalent among cancer patients com- pared with the general population with a reported standardized mortality ratio (SMR) of approximately 2 (McFarland et al., 2019). Through variability in study design, the time period of the study and populations studied, data have shown different averaged SMRs from 1.55 in a systematic review and meta-analysis from 2019, up to 4.44 in a 2019 U.S. populational study (Zaorsky et al., 2020). The discrepancies in reported SMRs may reflect that cancer patients constitute a heterogeneous population. For instance, head and neck cancer patients were reported to have up to three times the incidence of suicide when compared with the general population Patients with lung cancer and Hodgkins lymphoma have shown SMRs as high as 25 and 26, respectively, within the first year of diagnosis (Zaorsky et al., 2020), and prostate cancer has been associated with a high suicide mortality rate. Compared with patients with severe mental illnesses (such as major depression and psychosis), these suicide risk remains low. Nonetheless, even if it is rare in cancer care, suicide is an emotionally distressing negative outcome for the family and medical teams. https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1478951521000912 Downloaded from https://www.cambridge.org/core. IP address: 3.235.191.121, on 05 Nov 2021 at 00:34:20, subject to the Cambridge Core terms of use, available at