4, 9 Despite the substantial literature describing suicidality in patients undergoing cancer therapy, few studies have examined suicidal symptoms in the years after treatment. These include older age and male sex, certain sites of disease (eg, esophageal, pancreatic, and head and neck), higher stage disease, poor prognosis, poor physical functioning, depression, alcoholism, other psychiatric disease, hopelessness, fatigue, pain, loss of function, prior history or family history of suicide attempt, and lack of social support. Literature reviews on suicide in cancer patients 4, 9 have identified a large number of factors associated with increased risk of suicide. 5- 7 In a US study of deaths in a single county, Llorente et al 8 recently reported that risk of suicide among prostate cancer patients was 4.24 compared with the nondiseased population. 4- 8 Recent Scandinavian registry studies have reported standardized mortality ratios for suicide deaths in cancer patients from 1.55 to 2.5 for males and from 1.35 to 2.9 for females compared with the general population. 1- 3 Despite significant advances, cancer and cancer treatments can result in significant physical and emotional morbidity, and several epidemiologic studies indicate that the risk of suicide is elevated in cancer patients compared with the general population. Suicidal thoughts and behaviors are known to be associated with extreme emotional and physical suffering.
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