Suicide risk in pediatric cancer patients: An exploratory study

This descriptive, retrospective study was undertaken to identify suicide histories in children and adolescents at a pediatric cancer center and to identify potential suicide risk factors in this population. Physicians, nurse practitioners, psychologists and social workers at the Dana‐Farber Cancer Institute were surveyed to identify patients known to have made suicide attempts, successful or not. Medical and psychosocial histories, including specifics of the event, were obtained from a semi‐structured interview with the respondent and a review of the medical chart, and evaluated for psychosocial risk factors. Thirty‐eight clinicians identified 10 patients with suicidal events between 1974 and 1991: two successful suicides, four unsuccessful attempts, two deaths under unclear circumstances and two instances of self‐destructive behavior with unclear intent. Subjects ranged in age from 10 to 27 years at the time of the event (median age 16.34 years) and diagnoses included Hodgkin's disease (4), leukemia (2), Ewing's sarcoma, osteosarcoma, soft tissue sarcoma and neuroblastoma. Psychosocial risk factors or stresses of the current medical situation were present in nine out of the 10 patients (median score, 4 factors). Depression or hopelessness was present in eight patients, and stressful familial events (in addition to patient's illness) such as parental divorce, additional familial illness or financial pressures were present in seven patients. Current medical factors, such as advanced illness/poor prognosis and pain management issues, were present in three and two patients, respectively. Six out of the 10 subjects were off medical treatment at the time of their attempts. Suicide or suicide attempts in this sample indicated that medical factors alone are not adequate to explain the emotional states which may give rise to self‐destructive behavior. Psychosocial stressors from non‐medical sources appear to contribute to increased suicide risk for pediatric cancer patients. The finding that six out of 10 suicide attempts occurred in cancer survivors raises concerns about the special risk to this population. These findings suggest more extensive study is needed of suicidal behavior among pediatric cancer patients and, particularly, survivors of pediatric cancer. In addition to further identification of specific medical and psychosocial factors, the interrelationship between these factors needs to be better understood for its potential to contribute to suicidality in this population. The cumulative effect of chronic stress from medical factors also deserves further investigation.