Patient-oncologist alliance as protection against suicidal ideation in young adults with advanced cancer

Authors

  • Kelly M. Trevino PhD,

    1. Center for Research on Patients and Families Facing Serious Illness, Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York
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  • Caroline H. Abbott BA,

    1. Center for Research on Patients and Families Facing Serious Illness, Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York
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  • Michael J. Fisch MD,

    1. Department of General Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Robert J. Friedlander MD,

    1. Memorial Sloan-Kettering Cancer Center, Department of Medicine, Palliative Medicine Service, New York City, New York
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  • Paul R. Duberstein PhD,

    1. Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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  • Holly G. Prigerson PhD

    Corresponding author
    1. Center for Research on Patients and Families Facing Serious Illness, Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York
    • Corresponding author: Holly G. Prigerson, PhD, Weill Cornell Medical College, 525 East 68th Street, New York City, New York, 10065; hgp2001@med.cornell.edu

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  • See editorial on pages 2233–6, this issue.

Abstract

BACKGROUND

Young adults with cancer are at an increased risk of suicidal ideation. To the authors' knowledge, the impact of the patient-oncologist alliance on suicidal ideation has not been examined to date. The current study examined the relationship between the patient-oncologist therapeutic alliance and suicidal ideation in young adults with advanced cancer.

METHODS

A total of 93 young adult patients (aged 20 years-40 years) with incurable, recurrent, or metastatic cancer were evaluated by trained interviewers. Suicidal ideation was assessed with the Yale Evaluation of Suicidality scale, dichotomized into a positive and negative score. Predictors included diagnoses of major depressive disorder and posttraumatic stress disorder, physical quality of life, social support, and use of mental health and supportive care services. The Human Connection Scale, dichotomized into a strong (upper third) and weak (lower two-thirds) therapeutic alliance, assessed the strength of the patients' perceived oncologist alliance.

RESULTS

Approximately 22.6% of patients screened positive for suicidal ideation. Patients with a strong therapeutic alliance were found to be at reduced risk of suicidal ideation after controlling for confounding influences of cancer diagnosis, Karnofsky performance status, number of physical symptoms, physical quality of life, major depressive disorder, posttraumatic stress disorder, and social support. A strong therapeutic alliance was also associated with a reduced risk of suicidal ideation after controlling for mental health discussions with health care providers and use of mental health interventions.

CONCLUSIONS

The patient-oncologist alliance was found to be a robust predictor of suicidal ideation and provided better protection against suicidal ideation than mental health interventions, including psychotropic medications. Oncologists may significantly influence patients' mental health and may benefit from training and guidance in building strong alliances with their young adult patients. Cancer 2014;120:2272–2281. © 2014 American Cancer Society.

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