title: Clinical factors associated with suicidality in cancer patients.
abstract: BACKGROUND
  Previous epidemiological studies have indicated that the risk of suicide in cancer patients is higher than that of the general population. In addition, euthanasia and physician-assisted suicide (PAS) have recently become controversial medical, ethical and legal issues all over the world. Although suicide in cancer patients and appropriate management of cancer patients with suicidality are critical issues in clinical oncology practice, there have been very few studies to understand suicidality in cancer patients. The purpose of this study was to explore the clinical factors associated with suicidality in Japanese patients with cancer.
  
  
  METHODS
  We investigated the clinical factors associated with suicidality in cancer patients by analyzing the consultation data of patients referred to the Psychiatry Division, National Cancer Centre Hospital and Hospital East, Japan.
  
  
  RESULTS
  Of 1713 psychiatric referrals, 62 (3.6%) were related to suicidality, including 44 cases with suicidal ideation, 10 suicide attempts and eight cases who had requested euthanasia and/or continuous sedation. Most of the patients suffered from physical distress and/or psychiatric disorders. The results of a multivariate analysis comparing cancer patients with a psychiatric referral related to suicidality and those referred for other reasons indicated that impaired physical functioning and major depression were significant associated factors.
  
  
  CONCLUSIONS
  Our findings suggest that early detection and appropriate management of major depression and comprehensive care improving physical functioning may help to prevent suicide and manage suicidality in Japanese cancer patients.
authors.affiliation: Psycho-Oncology Division, National Cancer Center Research Institute East, Kashiwa, Chiba, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Akechi
authors.forename: Tomohito
authors.initials: T
authors.lastname: Nakano
authors.forename: Nobuya
authors.initials: N
authors.lastname: Akizuki
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Nakanishi
authors.forename: Eisho
authors.initials: E
authors.lastname: Yoshikawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Okamura
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Uchitomi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000523:psychology*; D011566:Psychiatric Aides; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013405:Suicide / Q000941:ethics / Q000523:psychology / Q000706:statistics & numerical data*; D017236:Suicide, Assisted; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data