Surviving Prostate Cancer but Succumbing to Suicide: Do Poor Health Outcomes Explain the Increased Risk?
Christopher Recklitis, Ph.D., M.P.H., Dana-Farber Cancer Institute
2011 Pilot Research Grant
Inside the Research
Bio: Dr. Recklitis received his doctorate from Boston University in 1993 and his master’s in public health from the Harvard School of Public Health in 2001. He is currently the Director of Research and Education at the Perini Family Survivors’ Center of Dana-Farber Cancer Institute and an Assistant Professor in the Department of Pediatrics at Harvard Medical School.
Research Categories: Prostate cancer, suicidal behavior.
Abstract: Men with prostate cancer are two to four times more likely to die by suicide compared with men who have never had prostate cancer. While the statistics clearly show this higher rate, little is known about what aspects of the cancer or health outcomes contribute to later suicide. Dr. Recklitis intends to determine whether physical health issues like pain, incontinence, and sexual problems following cancer treatment contribute to a cancer survivor’s suicidal ideation. The study involves a survey mailed to former patients of the Dana-Farber Cancer Institute to assess patients’ physical and mental health as well as suicidal ideation. It is expected that 500 men will participate. Dr. Recklitis’s study will be one of the first studies of suicidal ideation after prostate cancer to focus on the role of the patient’s health after treatment.
Impact: To understand the role physical health problems play in suicidal ideation and behavior, which may lead to educating physicians and developing new interventions to meet prostate survivors’ needs.
Cancer survivors have been shown to be more likely to have suicidal ideation than their same age peers. Prostate cancer survivors share this risk. They are also typically over 65, which puts them in an age group with increased risk for suicide.
We need to know more about the factors that contribute to this suicide risk.
Dr. Christopher Recklitis surveyed prostate cancer (PC) survivors who were first diagnosed 3 to 8 years before the study.
The survey asked survivors about suicidal ideation, depressed mood, suicidal ideation and demographic characteristics. The survey also inquired about pain, health-related quality of life, lifetime and recent recurrence, as well as the use of health services in the past 12 months.
The survey included:
- The 26-item Expanded Cancer Index Composite Instrument (EPIC-26) about symptoms and PC treatment.
- The Short-form 12 (SF-12).
- The Beck Depression Inventory.
- The Geriatric Depression Inventory.
The response to the survey was impressive, with 693 of 979 men completing the questionnaires.
- Over 12% of men reported some suicidal ideation, with 5.2% reporting active suicidal ideation and 1.4% reporting serious suicidal ideation—all higher levels than peers without cancer.
- Emotional and physical health, unemployment, pain, low income, and depressed mood (not clinically significant depression) were associated with suicidal ideation.
- Having a previous mental health condition related to suicidal ideation.
- Age, type of cancer treatment, time since cancer diagnosis, cancer recurrence, and other treatment factors were not related to suicidal ideation.
While most men fare well, some men with PC are at long-term risk for emotional and physical discomfort. Physicians should check in with patients about their pain (physical and emotional), address concerns about side effects and mood, and assess for suicidal ideation using several questions about different periods of time. For patients with pervious mental health conditions, a PC cancer diagnosis may increase their risk and extra attention may need to be given for their care and support.
Recklitis CJ, Zhou ES, Zwemer EK, Hu JC, Kantoff PW. Suicidal ideation in prostate cancer survivors: Understanding the role of physical and psychological health outcomes. Cancer. 2014 Jun 24. doi: 10.1002/cncr.28880. [Epub ahead of print] PMID: 24962506
Zhou ES, Hu JC, Kantoff PW, Recklitis CJ. Identifying suicidal symptoms in prostate cancer survivors using brief self-report. J Cancer Surviv. 2014 Aug 19. [Epub ahead of print] PMID: 25135206