Depression, pain, debility, hopelessness and a sense of being a burden to others have been identified as key risk factors for suicidal behavior.51,52 Recently, investigators have queried large databases and employed sophisticated methodology to study this important clinical problem. These data suggest that the suicide rate for persons with cancer is at least twice the rate observed in the general Inhibitors,research,lifescience,medical US population.53-55

Specific patterns of suicide have emerged from these studies that have direct clinical relevance. There is a differential risk of suicide depending on gender and cancer type, with prostate, gastrointestinal, head and neck, and lung Inhibitors,research,lifescience,medical cancers associated with higher rates.55-58 Suicide also tends to be more frequent within the first months after diagnosis and soon after discharge from the hospital.59,60 Consequently, the ability to assess depression and suicide risk should be considered a core competency for clinicians

who work with cancer patients. This is particularly important since oncology clinicians are often unable to identify depression and other factors that put their cancer patients at higher suicide risk, and Inhibitors,research,lifescience,medical only a minority of cancer patients are appropriately referred to mental health professionals.14,61,62 Desire for hastened death Few clinical scenarios generate a request for psychiatric evaluation more predictably than when a patient expresses a wish to die. Walker et al63 reported results from over 3000 patients screened for suicidal ideation in an outpatient oncology Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical clinic in Edinburgh, Scotland. Eight percent of patients endorsed thoughts of being better off dead or having thoughts of hurting themselves in some way. This communication can be

an expression of countless thoughts and feelings including the following: a passive wish to be free of suffering; a worry about future pain; an expression of need for control; a specific plan to commit suicide; a rejection of futile life-sustaining treatments (withdrawal of care); an acceptance of death; an elicitation of help in ending one’s life (physician-assisted suicide); or a request to these be killed (euthanasia).31,64-69 Under any circumstances, an endorsement of suicidal ideation or a request for an intentionally arranged death is an expression of distress that warrants Ceritinib careful clinical assessment. Muskin68 observed that physicians respond to requests to die by focusing predominantly on determinations of the patient’s DMC. He argued persuasively that too often there is inadequate attention to the underlying meaning and importance of these requests.