1. 1 Better Off Dead: Suicidal Thoughts in Cancer Patients Jane Walker, Rachel A. Waters, Gordon Murray, Helen Swanson, Carina J. Hibberd, Robert W. Rush,Dawn J. Storey, Vanessa A. Strong, Marie T. Fallon, Lucy R. Wall, and Michael Sharpe R2 Jeong Yoon Jang /Prof. Jae Jin Lee Original article J Clin Oncol. 2008 Oct 10;26(29)

2. 2 Introduction Advances in cancer treatments have improved the prognosis and quality of life of many patients, but cancer is still associated with an increased rate of suicide and of attempted suicide. Patients with medical conditions are more likely than the general population to report having these types of thoughts. what proportion of general cancer outpatients have such thoughts and which of these patients are most likely to have them. J Clin Oncol. 2008 Oct 10;26(29)

3. 3 Purpose By using questionare, which asks about thoughts of being better off dead and thoughts of hurting yourself insomeway, to determine the prevalence of such thoughts in cancer outpatients. examine the association of demographic and clinical variables with these thoughts. J Clin Oncol. 2008 Oct 10;26(29)

4. 4 Patients and Methods Design –A cross-sectional survey. Patients –outpatient department of the Edinburgh Cancer Centre, Scotland, United Kingdom – June 2003 and December 2006 – exclusion criteria : their initial assessment too ill cognitive impairment or severe communication difficulties. J Clin Oncol. 2008 Oct 10;26(29)

5. 5 Patients and Methods Measures 1. Patient health questionnaire-9. (PHQ-9) : depression -at least several days in this period (>1)  positive responders. 2. Cancer Center Clinical Database. 3. Hospital Anxiety and Depression Scale. (HADS) : anxiety, depression 4. European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C 30 (EORTC QLQ-C30) (>50) : substantial pain J Clin Oncol. 2008 Oct 10;26(29)

6. 6 Methods Procedure –Semi-automated symptom screening –questionnaires by using touch-screen computers Ethical Approval –obtained from the local research ethics committee. Data and Analysis –each patient’s first screening within the study period was used in the analysis. –first compared the characteristics –prevalence of positive responders –associations of a positive response with the following variables were analyzed—first by using univariate logistic regression, then by using multivariate logistic regression J Clin Oncol. 2008 Oct 10;26(29)

7. 7 Patients and Methods J Clin Oncol. 2008 Oct 10;26(29) Exclusion -communication difficulties, -cognitive impairment, -too ill. Patients refused to participate in screening or were not approached due to busy clinics

8. 8 Results J Clin Oncol. 2008 Oct 10;26(29)

9. 9 Results 7.8% (229) : at least several days in the preceding 2 weeks. 5.4% (159) : on several days 1.6% (46) :> half the days 0.8% (24) : nearly every day.

10. 10 Results J Clin Oncol. 2008 Oct 10;26(29) Clinically significant emotionally distress : HADS > 15. Substantial pain : EORTC OLO-C30 > 50.

11. 11 Results J Clin Oncol. 2008 Oct 10;26(29)

12. 12 Discussion (1) - Main Finding 8 % outpatients : having thoughts that they would be better off dead or thoughts of hurting themselves in some way for at least several days in the previous 2 weeks. clinically significant emotional distress and substantial pain (and, to a lesser extent, older age) were the only variables associated with a positive response. J Clin Oncol. 2008 Oct 10;26(29)

13. 13 Discussion (2) - limitation first limitation concerns the generalizability of the findings. - maynot be typical of other cancer services. second limitation concerns the measure. - self-completed screening measure, rather than an interview  lead to increased refusal of patients to participate in screening. third limitation concerns the data available for analysis, which were obtained from patients who participated in routine symptom screening. J Clin Oncol. 2008 Oct 10;26(29)

14. 14 Discussion (3) -Comparison With Other cancer patients have three times the general population risk of suicidal ideation. –In the general population, the prevalence of individuals who experience suicidal ideation has been reported as 2% to 25%. – JAMA, 2005 –South Australian community sample that used Item 9 of the PHQ-9 : 2.6% prevalence of positive response Patients who have medical illnesses have been reported to have a higher rate of suicidal ideation than the general population. –BMJ, 2000 – A study of patients who attended a neurology clinic and completed Item 9 of the PHQ-9, followed by a clinical interview, reported that 9% of patients experienced significant suicidal ideation J Clin Oncol. 2008 Oct 10;26(29)

15. 15 Discussion (4) - Implications for Practice Substantial number of patients report thoughts of being better off dead or thoughts of hurting themselves majority of patients who report suicidal thoughts will not attempt suicide, further assessment is necessary to identify those who are at high risk of doing so. Suicidal thoughts are most common in those cancer patients who have emotional distress and substantial pain.  identification of and treatment of these symptoms may not only improve a cancer patient’s quality of life but also contribute to reducing the risk of suicide. J Clin Oncol. 2008 Oct 10;26(29)