How oncologists can reduce suicide risk in prostate cancer patients

Men with prostate cancer are at increased risk of mental distress and suicide, but their oncologists can help, MedPageToday reported Dec. 6.

One study of 50,000 older men with prostate cancer found 20 percent develop a mental health illness. Only 50 percent of those men received treatment for depression or anxiety, according to Dr. Zachary Klaassen, a urologic oncologist at the Georgia Cancer Center at Augusta University.

According to a 2018 study, a majority of oncologists and nurses managing cancer patients reported at least one patient who experienced suicidal ideation or died by suicide during their career. Suicide risk factors include male sex, Caucasian race, older age and distant disease. 

"What is particularly interesting is that if we tease out the prostate cancer data, even at 15 years after diagnosis the standardized mortality ratio was 1.84 compared to the general population," Dr. Klaassen said in the report. "This really lends to the fact that these men are going to be high-risk even years and years after their diagnosis."

Oncology healthcare professionals experience a number of barriers to identifying suicide, including fear of asking, lack of coping resources, or lack of time or training.

Dr. Klaassen offered four ways to improve mental health practices in the oncology office:

  • Use the National Comprehensive Cancer Network distress thermometer, a 0-10 scale (none to extreme) in which patients indicate their level of distress over the course of the week prior to assessment.

  • Train staff to use and administer the thermometer. Have staff flag patients who score 3 or higher.

  • Create a list of mental health referrals.

  • When possible, work with psycho-oncologists and sexual medicine oncologists to help reduce mental distress.

"We're all prostate cancer doctors here," Dr. Klaassen said. "Your job is to treat prostate cancer the best you can, but make the referrals to your urology colleagues that deal with sexual matters and urinary incontinence, because it is in that localized state that they are going to have their issues. And make friends with your psycho-oncology team at the same time."

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