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Routine screening for suicidal intention in patients with cancer

Authors

  • Yvonne W. Leung,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
    2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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  • Madeline Li,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
    2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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  • Gerald Devins,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
    2. Princess Margaret Cancer Research Foundation, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
    3. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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  • Camilla Zimmermann,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
    2. Princess Margaret Cancer Research Foundation, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
    3. Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Anne Rydall,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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  • Chris Lo,

    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
    2. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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  • Gary Rodin

    Corresponding author
    1. Department of Psychosocial Oncology and Palliative Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
    2. Princess Margaret Cancer Research Foundation, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
    3. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
    • Correspondence to: Department of Psychosocial Oncology and Palliative Care, 16th Floor, Rm 724, Princess Margaret Cancer Centre, University Health Network, 610 University Avenue, Toronto, Ontario, Canada M5G 2M9. E-mail: gary.rodin@uhn.ca

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  • Preliminary findings from this research were presented in part at the Canadian Association of Psychosocial Oncology (CAPO) Conference in Vancouver, British Columbia, Canada, April 25–28 2012.

Abstract

Objectives

Suicide rates are elevated in individuals with cancer, although suicidal intention is not typically assessed in cancer centers. We evaluated in a large comprehensive cancer center the utility of an electronic Distress Assessment and Response Tool (DART), in which suicidal intention is assessed with a single item.

Methods

Patients attending cancer clinics completed DART as part of routine care. DART includes measures of physical symptoms, depression, anxiety, social difficulties, and practical concerns. Medical variables were obtained from the Princess Margaret Cancer Registry, the data warehouse of cancer patient statistics. A Generalized Estimating Equation (GEE) model was used to assess factors associated with suicidal intention.

Results

Between September 2009 and March 2012, 4822/5461 patients (88.3%) who completed DART consented to the use of their data for research. Amongst the latter, 280 (5.9%) of the 4775 patients who answered the question reported suicidal ideation, which was related to physical and psychological distress, and social difficulties (ps < 0.0001). Amongst those with ideation who responded to the intention question, 20/186 (10.8%) reported suicidal intention. Of respondents with more severe suicidal ideation, 12/49 (24.5%) reported suicidal intention. Using a GEE model, suicidal intention in those with ideation was significantly associated with male sex, difficulty making treatment decisions, and with everyday living concerns.

Conclusions

Suicidal ideation is reported on an electronic distress screening tool (DART) by almost 6% of cancer patients, of whom almost 11% report suicidal intention and 33% decline to indicate intention. DART demonstrated utility in identifying patients who may be at highest risk of completed suicide and who require urgent clinical assessment. Copyright © 2013 John Wiley & Sons, Ltd.

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